Inferred Values of Clothing Related to Adjustment Among Pregnant Women

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5-1972

Inferred Values of Clothing related to Adjustment Among Pregnant Women

Violet Elizabeth Dowdeswell Utah State University

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This Thesis is brought to you for free and open access by the Graduate Studies at DigitalCommons@USU. It has been accepted for inclusion in All Graduate Theses and Dissertations by an authorized administrator of DigitalCommons@USU. For more information, please contact [email protected]. INFERRED VALUES OF CLOTHING

RELATED TO ADJUSTMENT

AMONG PREGNANT WOMEN

Violet Elizabeth Dowdeswell

A thesis submitted in partial fulfillment o f the r equi.rement s for the degree

MASTER OF SCIENCE

i n

Home Economic s and Con sumer Educ ati on

Approved:

Thesis Di r~c?or

Major Professor

Committee Me mber

------Commit:..t.ae. Member bean mf Graduat e Studies

UTAH STATE UNIVERSI TY Logan, Utah

1972 ACKNOWLEDGEMENTS

Appreciation i s expr essed t o members of the thesis committee for their assi stance . The support and pat ience of Dr. Anne Kernaleguen, thesis direc tor , was great ly valued. She ser ved as a constant source of gui dance, i nspirati on, and moti vation. Special t hanks are extended to Gail Hi l l e r , major pr ofes sor , who contributed sympathetic reactions and constructi ve cr i ticism. Thanks are also extended to

Dr. David Stone and Bar bar a White, member s of the advisory committee, for suggestions for this project, and for contributions of time and effort.

The author wi shes to acknowl edge t he support of personnel from the Moose J aw , Rosetown, and Swift Cur rent Public Health Regions, who wer e most cooper ative i n maki ng an effor t t o ease the task of data col lection . Financi al assi s t ance t hrough an A. E. Wilson Grant given by t he Canadi an Federat ion of Univer sity Women, was greatly apprecia ted . The wr i t er i s also gr a t eful to Dr . Seymour Fisher for his assi stance i n s cori ng the Holtzman Protocols, and t o Dr. Elaine

Grimm for her expressed i nterest. The concern shown by Brian Ward, princ ipal and colleague , i s a l so recognized.

The aut hor i s greatly indebt ed to Anna Smith for her critical review of t he thesis and for her continui ng support. Finally, the author wi shes t o expre ss s incer e gratitude to her husband, Donald, for hi s underst anding and encouragement i n the undertaking of a master's degree.

Vi olet Eli zabeth Dowdeswell TABLE OF CONTENTS

Chapter Page

I~ INTRODUCTION 1

Nature and Origin of the Problem 1 Statement of the Problem 7 Objectives 8 Procedure 9 L~mitations 9

II. REVIEW OF LITERATURE 11

Pregnancy 11 Stress and Anxiety 19 Stress and Anxiety in Pregnancy 24 Body-Image 34 Cloth~ng-Related Behavior 40 Summary 49

III. METHODS AND PROCEDURE 51

Theoretlcal Framework 51 Hypotheses 52 Definit~oc of Terms 53 Se:e::tlon of Sample 58 Ir:st_'!':'urr~en ts 60 IFAT Anxiety Scale Questionnaire 60 H.I.Po Pregnancy Questionnaire 62 Body Boundary Index 64 Inferred Values of Clothing Inventory 65 General Information Questionnaire 68 Directional rating of variables 70 Test Administration 71 Analyses of Data 71 Dascriptlve 71 Statistical 71

IV< RESULTS 73

Characteristics of t.he Sample 73

RangeS:.1 Means, and Standard Deviations 78 Comparison with norms 78 Pearsonian Product-M.oment Correlation 82 Analyses of Variance 85 Coeff~c1ent of Concordance 88 Hypotheses and Results 92 TABLE OF CONTENTS (Continued)

Chapter Page

v . INTERPRETATION ~5

VI. SUMMARY, CONCLUSIONS, RECOMMENDATIONS 113

Summary 113 Conclusions 119 Recommendations 120

LITERATURE CITED 124

APPENDICES 134

Appendix A. General Information Questionnaire 135 Appendix B. Instructions to Members of Sample 136 Appendix C. Location of Sample 137

VITA 138 LIST OF TABLES

Table Page

1. Characteristics of six prenatal clinics in south west Saskatchewan by location, time, attendance, and procedure followed 59

2c Item-total intercorrelation matrix for four values of Inferred Values of Clothing Inventory with 56 pregnant women (Dowdeswell, 1971) and 179 college men and women (Hiller and White, 1971) 69

3e Directional rating of variables 70

4. Frequency and percentage distribution of 56 pregnant women by age, gravidity, trimester, pregnancy planned, residence, amount of educauion, occupation, work status, husband's occupation, and initial maternity clothing use 74

5. Ranges of scores, means, and standard deviations for all variables for 56 pregnant women 79

6. Comparison of means and standard deviations on IPAT Anxiety Scale Questionnaire 80

7e Comparison of means, ranges of scores, and standard deviations on Grimm's HeloP. Pregnancy Questionnaire 81

80 Comparison of means and standard deviations for Barrier and Penetration, scored on Holtzman Ink- blot Technique 81

9. Intercorrelation matrix for anxiety, H.loP. factors, body boundary, and values 83

10e Analysis of Variance comparing means for anxiety, H.loP. factors, body boundary, and values by trimester of pregnancy 86 lIe Analysis of Variance comparing means for anxiety, H.I.Pc factors, body boundary, and values by gravidity 87

12. Rank order of values on Inferred Values of Cloth- ing Inventory for 56 pregnant women 89

13. Significant agreement in rank order of values on Inferred Values of Clothing Inventory for 56 preg nant women 89 LIST OF TABLES (Continued)

Table Page

14. Rank order of values on Inferred Values of Clothing Inventory by trimester for 56 pregnant women 90

15. Significant agreement in rank order of values on Inferred Values of Clothing Invent.ory by trimester for 56 pregnant women 90

16. Rank order of values on Inferred Values of Clothing Inventory by gravidity for 56 preg nant women 91

17. Significant agreement in rank order of values. on Inferred Values of Clothing Inventory by gravidity fo.r 56 pregnant. women 91 ABSTRACT

Inferred Values of Clothing

Related to Adjustment

Among pregnant Women

Violet Elizabeth Dowdeswell

Thesis Director: Ore Anne Kernaleguen Department: Home Economics and Consumer Education

The first objective of this study was to investigate the adjustment of women during pregnancy through various indices, namely: level of anxiety, att,i tudes to pregnancy, and perception of body- image boundaries, and to investigate the relationship among these indices. A second objective was to determine if a significant rank order of values inferred th~ough clothing exists among pregnant women, and to r'elate these values to the measures of adjustment.

The comparison of women by trimester and gravidity on the measures of adjustment and the inferred values, was a third objective.

The theoretical framework proposed that adjustment to the stress of pregnancy has important implications for the mental health and welfare of mother and child. It was also based on research findings that the subconscious evaluation of body boundaries is an index of adjustment, as is level of anxiety and attitudes to pregnancy_ The interdisciplinary approach to the study of clothing postulates that clothing can facilitate adjustment by serving as an extension of self, as reinforcement of boundaries, and as a communicative factor. Value ;s central to understanding and predicting behavior, there analysis .... e values pregnant women seek to reinforce through clothing fore, th should provide insight into the function of clothing in adjustive behavior. The sample of 56 pregnant women was selected on a non-random basis from prenatal clinics in southwest. Saskatchewan. The instru ments administered were: Cattell's IPAT Anxiety Scale, Grimm's Hel.P. pregnancy Questionnaire, Holtzman Inkblot Protocols, Kernaleguen's

Inferred Values of Clothing Inventory, and a General Information

Questionnaire.

The analyses revealed: (1) significant association among anxiety and factors ~n attitudes and adjustment to pregnancy, and some of the inferred values of clothing; (2) relationships among factors in attitudes and adjustment to pregnancy and the four inferred val ues of clothing; (3) positive correlation between Barrier and Pen- etration, but no significant relationships among Barrier or Penetra- tion and the other indices of adjustment or the inferred values;

(4) significant difference in Penetration among subjects in each trimester of pregnancy; (5) no significant difference between primi gravidae and mult~igravidae on any of the variables; (6) significant rank order of inferred values among all subjects, by trimester and gravidity, with value for physical comfort ranked highest. and the social values ranked loweste

The theoretical framework received some support. High level of anxiety was related to negative attitudes to pregnancy. The rela tionship of the measures of adjustment with the more subconscious concept of body-image was not clearly establishede A number of recommendations are included~ (146 pages) CHAPTER I

INTRODUCTION

Nature and Origin of the Problem

pregnancy is believed to be a period of stress which a large percentage of women encounter. The Dominion Bureau of Statistics reported 388,162 Canadian women of a total female population of

9,960,536, were pregnant during 1966. (Dominion Bureau of

Statistics, 1971) However, surprisingly little scientific re search has been undertaken to describe the dynamic development of the emotional life of the pregnant woman.

Pregnancy, like other processes of growth which involve psychological and somatic changes, results in a disturbance of the body's equilibrium. (Stone, 1965) Stress that causes high levels of anxiety often results in the development of behavior patterns which, when extreme, impede self-realization and socialization. (Sawrey and Telford, 1971)

Studies of human behavior under conditions of stress indicate that stress results in anxiety. (Sawrey and Telford,

1971) Most theorists studying personality place great emphasis on anxiety as a motivating force in life adjustment, whether the anxiety be a result of the external environment, or of factors involving self dynamics. (Fromm-Reichmann, 1955) It has been established that changes in life style require adjustive be havior, and this adjustment is essential for mental health.

(Sawrey and Telford, 1971) Empirical research dealing with stress 2 has been limited to a study of artificially induced stress rather than stress emanating from naturally occurring events. (Appley and Trumbull, -1967)

At present, there appears to be increasing interest among researchers &n the effects of anxiety and stress on the psycho logical course of pregnancy and the behavior patterns of the normal fetus. A higher incidence of complications during preg nancy has been demonstrated to be associated with maternal stress, perhaps reflected in the mother's emotional attitude toward the pregnancy. (Grimm, 1961; Davids and DeVault, 1962; McDonald,

Gynther, and Christakos, 1963) Grimm (1961) found that psycho logical tension was related to the trimester and also to gravidity (first or subsequent pregnancy). Early psychological assessment of pregnant women holds out the promise of being able to predict the course and outcome of pregnancy. (Grimm and Venet,

1966) It is therefore imperative to know more about the level of anxiety in people under a natural stress such as pregnancy.

There is support among researchers for the theory that body schema is important to mental health. Certain patterns of behavior are related to the organization of one's perceptions of one's body. In 1968 Fisher and Cleveland used the term Barrier to mean an abstract measure of body-field perceptual differentia tion or, "the body as experienced". They concluded that knowing the degree to which a person experiences his body boundaries as firm and definite or weak and lacking in demarcation, enables pre diction of certain aspects of behavior such as resiliency in the face of stress. They also concluded that definiteness of 3 boundaries or a high Barrier score was linked with various modes of behavior that constituted self-steering behavior. Those individuals who exhibited the ability to cope with stress and were self-directing, were found to have high Barrier scores. (Fisher and Cleveland, 1968) Fisher and Cleveland (1968) postulated a second aspect of body boundary, the Penetration of Boundary score, which implies vulnerability or weakness of body boundaries.

Megargee (1965) viewed the body boundary index as a measure of adjustment or fitness since high scores are associated with adaptive behavior and low scores with maladjusted ,behavior.

McConnell and Daston (1961), in a study of women under the stress of pregnancy, showed that a high Barrier score was linked positively with favorable attitudes toward pregnancy. Some data suggest that in the absence of a body-image boundary capable of supplying constancy in new situations, the individual finds it necessary to create exterior conditions which could artificially provide a substitute boundary. (Fisher and Cleveland, 1968)

Although Fisher and Cleveland (1968) contend that Barrier is essentially a subconscious construct, they also recognize the importance of the socialization process and the internalization of the attitudes and values of significant others. As Barrier is a body-image concept, and body-image is one factor in the • total self-concept picture, Barrier is therefore a sensitive indi- cator of a person's sense of self in social relationships.

There is a dearth of research relating adjustment during pregnancy to clothing and appearance. However, clothing is of necessity involved in physical and psychological adjustment to 4 pregnancy because it has to accommodate the changing size and shape of the body. After interviewing 40 pregnant women, Carty

(1970) reported that the way a woman saw herself in maternity clothes was an indication of her satisfaction or dissatisfaction with figure changes. Carty (1970) concluded that medical personnel who are conscious of the importance of body-image in pregnancy can, by stressing clothing and appearance, reinforce positive feelings and prevent, reduce, or remove negative feelings of the wife, husband, or family during pregnancy.

Only recently has attention been focused upon research into the many implications of clothing5 Early scholars recognized the intimate relationship between clothes and psychological variables • of a body-image order. (Garma, 1949; Schilder, 1950) Because behavior is largely determined by one's self-concept, self theorists suggest that clothing takes on subjective meaning when it is a means of projecting, defending, and vindicating the self.

(Jersild, 1952) Hartmann (1949) emphasized this theory by stating that clothing is useful in helping build up the person because it is related to ego-enhancement.

Studies by Stepat (1949) and Ryan (1966) confirmed a relationship among self-esteem and social and emotional adjustment with the emphasis placed 9n clothing. Through clothing one may express individuality and convey many facets of his personality such as confidence. Clothing may also be used to obtain desired rewards such as comfort and security. (Horn, 1968) Findings from studies pertaining to personality projection through clothing are inconsistent. (Ryan, 1966) It would appear that interest in 5 clothing for the self is related to the adjustment a person makes to his environment. If the concept of self provides the key to understanding mental health, it seems likely that clothing could serve to enhance the self, and consequently could be a factor in adjustment. Jersild (1952) maintained that one can study a person's self in a non-threatening manner by way of his clothing.

Followers of social interactionist theory suggest that appearance is important for establishing and maintaining the self in social situations. (Stone, 1962) Clothing, because it is such an integral part of our material culture, act? as an impor tant nonverbal cue in communication. Extensions of the self are developed as one discovers that one's worth, in the eyes of others, is partly a result of the value placed on things extraneous to self, such as clothing, housing, and other possessions. (Sawrey and Telford, 1971)

Studies by Compton (1964, 1969) and Kernaleguen (1968) hypothesized that clothing, as an extension of the body, serves the purpose of reinforcing body walls or transforming the body image. Compton (1964) studied psychotic women and found that those characterized by low Barrier scores tended to reinforce body boundaries through their fabric choices for clothing, while

Kernaleguen (1968) concluded that college women with low Barrier scores attempted to reinforce body boundaries by wearing fashionable attire.

Clothing has communicative value in adjustment to roles.

Because clothing yields overt evidence of role enactment, it can facilitate role change. (Treece, 1959) A change in life situation 6 such as pregnancy, is made evident through clothing. Treece (1959) discussed the possibility that the pregnant woman perceived herself as performing an important and relatively short role.

Her clothing had to contribute to the successful performance of this major social function.

Actions, judgement, and perception are all influenced by values. When a person's values are known, it often becomes possible to predict his behavior in given situations. (Combs and Snygg, 1959) Value analysis is central to understanding be havior because values are directly involved in an individual's existence as a self. (Rogers, 1951) In reviewing the instruments used in measuring values, Robinson and Shaver (1969) suggested that values are assumed to be central to the way a person orders his environment, and even to the way he defines himself. If ad~

justment to a stress such as pregnancy can be influenced by cloth ing, it is important to know whether there is agreement among values inferred. The values pregnant women seek to reinforce

through clothing could suggest approaches to adjustment during pregnancy. Differences in value orientation have been found to parallel differences in body-image boundary definiteness. (Fisher and Cleveland, 1968)

Research studies of pregnant women have been restricted to

studying the effects of emotions on ease of delivery and outcome of pregnancy. Pregnancy is repeatedly referred to as a state of

stress. Although adjustment is proclaimed to be essential to mental health, studies examining level of anxiety during pregnancy and ways of facilitating adjustment to pregnancy, are few. Body- 7 image boundary has been studied in relationship to adjustment under stress, to certain aspects of clothing choice, and to values.

However, the interrelationship of these factors with pregnancy has not been examined. It is possible that people with a high

Barrier score use clothing in a different way from that used by people with weak body boundaries. Since a person's value system is intimately involved with his behavior, particularly adjustive behavior, the values inferred through clothing are seen as the clothing variable most worthy of investigation. Questions remain unanswered about the relationship of clothing to various personal ity variables and manifest behavior, especially with pregnant women. The function of clothing during a period of adjustment has to be understood if the potential of clothing in maximizing human well-being is to be realized.

statement of the Problem

Pregnancy is believed to be a period of stress, the psychi atric management of which has important implications for the mental health and welfare of both mother and child. To date, the accumulation of research findings concerning the dynamic develop ment of the emotional life of the pregnant woman, is inadequate.

Adjustment to internal and environmental changes is a key factor in mental health, so an examination of adjustment during pregnancy could provide information concerning ameliorative possibilities.

One aspect of mental health is self-concept, in which body image plays a significant roleo This body-image approach has been fruitful in analyzing psychological and somatic changes and 8 predicting behavior under stress. In addition, level of anxiety and attitudes regarding pregnancy function as indices of adjust ment. If the concept of self provides the key to understanding mental health, it seems likely that clothing can function to enhance the self and consequently could be a factor in adjustment.

The values pregnant women seek to reinforce through clothing could suggest approaches to adjustment during pregnancy.

Objectives

Three main objectives have been formulated for this re search study.

1. To investigate the pregnant woman's level of adjustment

through the administration of a variety of indices of

adjustment, and to determine the relationships among

level of anxiety, attitudes toward pregnancy, and

body-image boundary.

2. To determine if there is communality of agreement in

the rank order of inferred values of pregnant women,

with respect to clothing, and to relate these values

inferred through clothing to the measures of adjustment.

3. To compare the women in each trimester, and primigravidae

with multigravidae, on the measures of adjustment and

the inferred values of clothing. 9

Procedure

1. Select a sample of pregnant women and administer the following

instruments:

a. Cattell's IPAT Anxiety Scale

b. Grimm's H.I.P. Pregnancy Questionnaire

c. Holtzman Inkblot Protocols for Barrier and Penetration

d. Kernaleguen's Inferred Values of Clothing Inventory

e. General Information Questionnaire, developed specifically

for this study.

2. Score all the standardized tests and code the data from the

General Information Questionnaire.

3. Analyze descriptively the general information and compare the

results of the standardized tests with the norms.

4. Investigate the data statistically and interpret the findings

with reference to the theoretical framework.

5. Summarize and evaluate the study and make recommendations

for further research.

Limitations

The limitations of this investigation are as follows:

1. The sample was chosen on a non-random basis since it was

not possible to identify the total population. There

fore, generalizations cannot be made beyond this

population.

2. A consistent approach to the sample may not have been

achieved due to differences in introductory information

prior to the testing date by outside personnel. 10

3. The testing situation itself might have contributed to

conditions of stress.

4. Pregnant women who attend prenatal clinics may have

characteristics different from pregnant women who do

not attend prenatal classes.

5. Uncontrolled variables may affect the results. 11

CHAPTER II

REVIEW OF LITERATURE

Theory and research pertaining to the states of pregnancy and stress are basic to this research. The frame of reference for discussing personality variables, the body as a psychological construct, will be surveyed in relevant literature. Clothing will be examined from the viewpoint of importance to the self, and as a media necessary for social interaction. This chapter will be organized under the following headings: pregnancy, stress and anxiety, stress and anxiety in pregnancy, body-image, and clothing related behavior.

Pregnancy

Pregnancy has been thought of as a biological event necess ary for the procreation of the human race. Much research has ex plored the nature of the physical and biochemical changes inherent in this process, but only recently has research explored pregnancy as a psychological state.

Kroger and Freed (1962) stated that to bear a child required psychological fitness as well as physical well-being. The demands of pregnancy made on the woman's physical and emotional reserves could upset physical and emotional equilibrium. (Kroger and Freed,

1962) Richardson and Guttmacher (1967) prefaced their collection of articles on the social and psychological aspects of childbear ing by stating that certain reproductive disturbances such as 12 spontaneous abortion, prematurity, and pseudopregnancy have been only partially explained by an emphasis on the physiological aspects of pregnancy.

The awareness of pregnancy creates unlimited variations and combinations of emotions in the expectant mother. Perlman (1968) suggested that the demands of pregnancy and the expectations of parenthood were sometimes met with feelings of accomplishment, ~ contentment, ambivalence, or shock. Stone (1965) supported the view that ambivalence was almost always present and that it might be expressed psychosomatically.

Grimm (1967) described psychological and physiological functioning of pregnancy as two interacting forces. In a later dis- cussion concerning women's psychology and physiology, Bardwick

(1972) postulated that there was a close two-dimensional relationship between a woman's psychological functioning and her reproductive system. The reproductive system had been shown to produce distinct effects on personality, and women of varying personalities used their reproductive systems to act out their conflicts, anxieties, and needs. Habitual abortion and traumatic vomiting during pregnancy were cited as examples of psychosomatic symptoms.

(Bardwick, 1972)

Confidence in regard to femininity was found to be important for adequate preparation for motherhood. (Caplan, 1957) Later,

Bibring (1959) compared pregnancy to other life situations which also involve psychological and somatic changes.

In pregnancy, as in puberty and menopause, new and in creased libidinal and adjustive tasks confront the in~ dividual, leading to the revival and simultaneous 13

emergence of unsettled conflicts from earlier develop mental phases and to tbe loosening of partial or in adequate solutions of the past. This disturbance in the equilibrium of the personality is responsible for creating temporarily tbe picture of a more severe disintegration. (Bibr~ng, 1959, p.116)

In every individual, pregna0CY produces a conflict between

the instinct to reproduce and the instinct for self-preservation,

stated Kroger and Freed (1962). Ferreira (1969) also recognized

that to be pregnant was to be committed. In 1962, Corbin, Brown,

and Hugnes, observed that obstetric advances had effected a decline

in maternal mortality, but the satisfaction of the total needs

of the mother had not been accomplished. Because pregnancy involves

a constant reappraisal of the self, a personality assessment of

the pregnant woman is necessary to evaluate the emotional compli-

cations of pregnancy, labor, and the post-partum period. (Kroger

and Freed, 1962)

Perlman (1968) stated that a woman's feelings about pregnancy were a complex combination of her sense and conception of self.

A study in 1969 by Wenner et ale concluded that pregnant women did what they felt was expected of them as a substitute for establish-

ing a firm self-image. This study also discussed other factors

that affected the psychological course of pregnancy - the motiva-

tion for the pregnancy, the solidity of the woman's feminine

identity, and the relationship with husband and parents. Dick-Read

(1968) emphasized the importance of a healthy emotional development, adequate sex education, and a well-handled adolescence.

A study by Grimm and Venet (1966) concluded that it was important from a mental health standpoint to determine what variables l4 influenced optimal adjustment during pregnancy. Their research aimed to develop measures for adequately assessing the emotional adjustment and attitudes of pregnant women. Emotional adjustment and attitudes as measured early in pregnancy, were investigated and found to be related to attitudinal characteristics and emotional adjustment later in the maternity cycle.

Pregnancy appears to create a crisis that affects all pregnant women, but for the person without an internal sense of balance, emotional problems may become acute. Perlman expressed:

Pregnancy is a crucial period then, even at its most even keel in the sense that it is a period of rapid and deeply felt body change and growth with its accompany ing physiological responses. (Perlman, 1968, p.120)

Whence do attitudes toward pregnancy come? A number of studies have investigated attitudes and adjustment to pregnancy as they related to a variety of societal factors. Corbin, Brown, and

Hughes (1962) suggested that the way in which the childbearing needs of families were met, Was a reflection upon the values of a society.

At the same time, this study suggested that many problems of pregnancy were caused by society.

Dick-Read (1968) believed that a mother was considered a valuable member of sOCiety and that she occupied a certain status in her home and community. Although the desire for self-fulfillment through creation at a biological level was found to be a dominant motivation in many women, Klein, Potter, and Oyk (1950) reported that pregnancy was also desired as a means of securing status within the woman's family. For some women, pregnancy was also a means of insuring the love of a husband. 15

Research has indicated that an uncomplicated pregnancy de- pends on the success of the marital relationship. (Wenner et al.,

1969) The husband's role in the childbearing process was recom mended for future study. Earlier, stone (1965) found that a preg nant woman's reactions were influenced by the real or imagined

responses of her husband. The relationship of marital satisfaction

and pregnancy of 407 primiparous couples was investigated by

Meyerowitz (1970). He concluded that a woman accepted pregnancy when it served to hring her closer to her husband, but rejected pregnancy when it excluded her from him. One index assessed the

importance of the husband's satisfaction with his wife's physical

attractiveness.

carty (1970) suggested that appearance was important. The husband/wife relationship might be strengthened if the wife was pleased with the way she looked during pregnancy. Furthermore,

dissatisfaction with her appearance might cause the woman to blame the baby and consequently have difficulty developing a

close relationship with the infant. (Carty, 1970)

The impact of pregnancy involves changes in familial relation-

ships and the role system within the family. (Caplan, 1957)

Stone (1965) concluded that the indications of acceptance, am bivalence, or rejection of pregnancy, stirred up responses and

repercussions in the family. These in turn set up reactions in

the pregnant woman. The reactions she perceived from her key

reference group members, especially her husband, could add to

interpersonal distress during pregnancy. (Stone, 1965) Kroger

and Freed (1962) noted that the number of previous children, the 16 timing of the pregnancy, and certain economic factors, might be important in the adjustment of the family to a pregnancy.

In 1959, Bibring objected to the clinical approach to child bearing. The progress of knowledge and techniques may have removed the psychological understanding, emotional support, and the human approach, which are important to the pregnant woman. In addition, in a rapidly changing world, the traditional supports offered by the extended family have been lost. This lack of support may cause the pregnant woman to attempt to adjust by internalizing all her emotions. Our society, in comparison with more traditional ones, lacks the mechanisms of customs, for helping the woman cope with this crisis period. (Bibring, 1959) Wenner et ale

(1969) concluded that measures to overcome the feelings of isola tion often present in pregnant women, could be expected to reduce difficulties during pregnancy.

Lubic (1969) proposed that anthropology could make contribu tions to the field of maternal care. Behavior patterns, values, preferences, and habits, taught by our society are employed with out thinking. Patterns of body care and adornment during pregnancy are influenced greatly by these sociocultural concepts. Richard son and Guttmacher (1967) stated that accepted values would be use ful in predicting customs and practices, and that these in turn would influence reproductive behavior.

In our North American society the positive and negative feelings about pregnancy, have caused pregnancy to be vague and undefined in comparison with other cultures. Goshen-Gottstein

(1966) based a study of Israeli pregnant women on the premise that 17

the understanding of the psychology of the expectant mother

might be increased if extensive information concerning her mar

riage background and ~mmediate environment were collected. She

classified her sample of women as traditional, modern, or transi

tional in their life stylee The traditional woman attempted to

exploit her pregnant situation to make up for the lack of concern

and attention given her as a persono As a result, she showed many

symptoms during pregnancy. This woman also tended to have a neg

ative attitude towards her bodyo The modern woman enjoyed a rel

ationship of equality with her husband and could fulfill her mater

nal role as well as function outside the home. The transitional

woman was concerned with socially determined behavior and attitudes,

but was less passive and subservient than the traditional woman.

She experienced a positive attitude toward her body, described

pregnancy as a pleasant experience, and suffered from fewer symptoms

than her traditional counterpart.

In 1964, Rice identified the following cultural aspects com plicating pregnancy: lack of marriage and parenthood education; desire to keep working or the necessity to do so; failure to com plete school education. Illsley (1967) listed social conditions

and behavior influencing the course of pregnancy as: socioeconomic

status; place of residence; illegitimacy; prenuptial conception.

Even biological categories such as maternal age and parity were considered socially significant factors. The risk of pregnancy, particularly involving illegitimacy, was related to censure of certain forms of behavior by society. 18

The concept of social class, which classifies people in our society in terms of their distinctive life styles, has also been studied with respect to pregnancYe Richardson and Guttmacher (1967) surrunarized that studies showed a greater risk of pregnancy and de livery complications and premature births among women of lower social class than among those of upper social class. Rosengren

(1961), in exploring the relationship of pregnancy and social status, found that women who shewed a high degree of social instability tended to view pregnancy as an illness, hence they had negative social aspirations. Rosengren 1961) also postulated that women with high occupational status felt a decrease in social position due to pregnancy, whereas, pregnancy could actually increase the S+;;ttus of a wcman on a lower level.

Acceptance of pregnancy is the prescribed cultural norm.

(Stone, 1965' This statement was upheld by Caplan (1957) when he explained that in our society, having a baby is assumed to be an

important goal for the young married woman, while at the same time! mal;,y cuI t.ural, social, and economic factors run counter to this aim. Kroger and Freed (1962) had previously suggested that the physical, social, and economic limitations imposed by pregnancy might cause resentment. When pregnancy is a socially expected and desirable condition, the woman feels affirmed by society's respect for her. These studies seem to show that adjustment to pregnancy requires an understanding of personality, within the societal framework of each individual. 19

stress and Anxiety

Early studies examining the nature of stress were carried out by Hans Selye {1956. As a result of extensive physiological examination, the conception of the general adaptation syndrome

(G.A.S,) or stress syndrome occurred. Selye (1956) defined stress in terms of the homeostatic mechanism of the body, and the life process of adaptation.

Appley and Trumbull (1967) edited reports that had originally been presented to a conference concerned with the issues of research on psychological stress. The editors observed thai stress was a state of the total organism under extenuating circumstances, rather than an event in the environment. Many environmental conditions were capable of producing a stressful state, but in turn, many responses could be given to a common stimulus by different indi viduals. Intra-individual response patterns occurring in stress situations were consistent, while inter-individual responses were varied. It was also concluded that the intensity and extent of the stress state could not be predicted from a knowledge of the stimulus conditions alone because personal motivation was also an important factor. The understanding of the interaction of one stressor with another was considered imperative. (Appley and

Trumbull, 1967)

Pepitone (1967 ) believed that although there was no one cor rect definition of stress, there were at least three ways of charac terizing stress. First, stress is a disturbance which the organism tries to eliminate; second, physiological or behavioral responses 20

which are symptoms of a disturbing inner state; and third, as an

event of the physical or social environment which leads to avoid

ance, aggression, or problem-solving methods to remove the condition *

Lazarus (1963) perceived states of stress as obstacles in

personal adjustment to the internal and external demands of the

environmentc Adjustment is reduced as stress interferes with think

ing and narrows the perceptual field. Stress reactions were de

fined as "reflections or consequences of coping processes intended

to reduce threat". (Lazarus, 1967, pe159) Lazarus emphasized the

role of the cognitive processes which underlie the .observed pattern

of reaction, and stressed the importance of taking into account

individual differences.

More recently, Holmes and Masuda (1970) investigated stress

ful life events and their bearing on illness susceptibility. It

was postulated that the life-change event,s evoked adaptive efforts

that were fa~lty in kind and duration, and consequently enhanced

the probability of disease oC'currencee The Life-Change Units

Scale assigned a numerical weight to each type of life change,

such as pregnan~y. Any of the changes required adjustment and

8oping, and Holmes suggested that it was the general rate of change

itself, rat"her than the partlcular type of change that correlated with illnesso (Holmes and Masuda, 1970)

Sawrey and Telford 1971} stated that "adequacy of adjustment

IS related more to one1s means of coping with stress than with the

extent of stress". (Sawrey and Telford, 1971, p.40S) Appley and

Trumbull commented: ".e. stress is a concept which can have 21 interpretation and rele.vance at many levels of human organization,

1 from cellJlar to cult.uxall1 0 (Appley and Trumbull, 1967 I po12)

The relationshtp between stress and anxiety is confusing 0

Lazarus (1963; suggested that anxiety is the affective aspect of stress! while 3awrey and Telford (1971;; stated that stress engenders

:::t'1X2e.tyo Ot=her explanations and definitions abound 0 Anxiety in its milder forms :Ls a unl,versal phenomenon with both disintegrative and c~nstructive fasetso (Fromm-Relchmann, 1955) Coleman (1964) def.~ned stxess as "any ::cnditlon impinging on the organism which

requ~.res adjust.i va reactions II 0 (Coleman ,f 1964, pe6}1) Cat.tell a!1d Scheler (1958) !'eported that~ "anxiety is generally conceded t.:::- be a phen:::meno!l that manlfests it.self in lrmnediate experienc::€ as aI). un,pleasant emotio~>al feeling wi th a:;haracteristic ant.icipa- tory character - the expe~tation of impending danger "0 (Cattell

and Schei.er tI 1958, po 351) The Dict10nary of the Social Sciences states:

Anx1ety may be defined as a reaction of apprehension r.anging f.rOID un€.asiness to complete panic preceded by a real cr symbolic condition of threat which the per son perceives diffusely and to which he reacts with an i.ntensity that tends to be disproportionateo (Gould and Kclb" 1964, pJ30)

Cattell and his associates (1958, 1960j have systematically

S~lJdie:d dr:Xl.e.ty using multivariate analysesc Their work is based upon the prinC:.iple that a separate state exists if a distinct re-

sponse patt~err:, factor can be found 0 States cannot be defined only by the st,imuli whi-::h cause them because many different stimuli

t,rigger the same response c CCatte.ll" 1957)

l'h~rteen mul tiYdriate analyses isolated t:he single state-trait anxiety factor U.10240 (Catte.ll and Scheier, 1958) This anxiety 22 factor was a seven-factor theory, consisting of ego weakness, super ego st.rengt"h or fear of deprivation, general or repressed drive

(id pressure), general ti.mi.di ty, protension or paranoid expression, lack of integrati.on, and, constitutional difficulty in sublimating.

(Cattell, 1957 Of these seven, the largest single source of high anxiety was la~k of integration, 17esu1ting in conflict and in effective argar::~z:ation of channels for the discharge of ergic ten sianG Anxiety was interpreted as both a state and a trait because c:hang1ng :::ircumstances result .l,n varying levels of stress, but there is also evidence that some people vary in general anxiety

l~vels c (Ca~tell, 1965) The IPAT Anxiety Scale was built up from a r:"ombinaticn of items on the questionnaires concerning anxiety that were fa~toz analyzed by C~ttell (1965)~

The relationship of stress and anxiety to various personality characteristics and social factors has been examined, but very

li,tt..le information has been obtained 0 (Appley and T:rumbull, 1967)

Few experiment,s are comparable because they employ different kinds of instruments under different conditionso (Lazarus, 1963) Lazarus

(1963) rec;ognized the usefulness of being able to predict which people would be adversely affected by a stressful situationc

A study of 200 adclescents attempted to investigat"e the re lationship between anxiety and the representation a person has of

himself c (Tome' and Zlotowi.cz, 1968) The anxiety scores were posit~.vely correlated with egoism, whi.ch was considered by the authors to be a devalued aspect of personalitYe Scores on self maste.ry and autonomy were negatively correlated with anxiety levele

Results also indicated a significant difference in anxiety scores 23 accardi~g to sex, but ~ct ac:~rd~ng to age~

Pep,: ~.~""Q (196"" hyp:)~.hes.~z2d a :':6 la.t :.::n:ship between stress ard se.lf dyr:3c1T.~~S, Pe.::f~rmar::-e lJ.r;der stress has beec :1egatlvely ccr~e:a:ed wIth subrriss:veness !~ children (Taylor and Faxber,

1948 , ::;w :nte:llgence,Lazar'~s and Eriksen, 1952 , and with l~w

Cattell and Scheier

~9E: rsp::"':"ted s~'~!d~es WhlCh :::onfi~J~med that subje;;t,s with higher any~ety ~sp=!~sd lees fav~Kable :ews of themselyesn Gergen and

Mar :~ :;:we 19-C pes:: ~.;;.la ,:ed tha. t-..;.~~der stress the per sen low J.!1 self-

rega.~d !r'ay beg::r mr;rs rapidly,,:.. : dero:;.ns: ra t;e anx~c:us behavior c

B€""::ause an:x~ €:. y W30Y .1.nte:: fere w ~ th c :;gr.l.~.i '\:re pIG:: Esses and problem s::'.! '-:r.g, ,,:;h~s pe:::s::n may als:: be m:;re !6ceptive to the. opinions

C~l~~=al lssues su~h as 1=55 =f ~c: al function, physical

Lazarus

~al~es a~d cu~~ural!y deve:=psd Fatterns cf behavior, as external

Ccn:ept.ual amb~gul. t~es ha~.·€ res1Ji':~ed because of a lack of

Texminology has been a p!Cb~9m- Freque~t:y the terms stress and anxiety have bee~ used l~ter=bangeably. "Cattel!, 1957 cattell's extensive

In 1960, Cattell and Scheier stated ~.hat h:>th s':.-.rsss ard arxlcety stim'J,lJ.. were defined as pro-

Stress stimuli possessed 24 the quality of evoking a great. deal of physical and mental effort, whereas anxiety stimuli seemed to affect or threaten the individ ual'S massive life purposes, or more specifically, his sentiment systemsc The conclusion that has been drawn from the literature reviewed, for the purposes of this study is that the level of anxiety, during a period of stress, is defined as a measure of the individ

ual! s adjust.ment t~i I or coping with I stress 0

Stress and Anxiety in Pregnancy

The temporary impairment of an individual's u9ual capacity t.o ~ope with changing env.l,ronmental stresses is a characteristic of pregnan~y. (Stone, 1965; In fact., stone felt that. "it is a rare wcman who adJusts t.~ pregnancy with no stress" ~ (Stone, 1965, p~88) Caplan (1957) elabcrated by proposing that pregnancy may impose st.ress on biological and physiological functioning, and in many cases lead tc a disequ.ilibrium of the interplay of social, cultural, and economic forces. Earlier, in an article for medical personnel, Caplan (1954) stressed thE:. importance of ego-strength ening support! and a.n:tic:ipatcry guidance in creating an atmosphere conduc:i ve to good mental hygiene· in the mat.erni ty pa tient ~

In 1968, Di:;k-Read hypothesized that anxiety was a psycho logical state in wh1ch the individual lives in a state of tension, l..lsua.lly associated wi.th a subconscious expectation of some sort of troublec This is the type of anxiety that women experience duri.ng pregnancyc

The universa11ty of anxiety during pregnancy seems to be indi~ated by t.he followi.ng studieso Hirst and Strousse (1938) , 25

reported an in:::;,rease in expressed anxiety during pregnancy by 75

percent of 100 women Interv1ewedc These anxietl€S were diverse

in type and of relative irnpcrtan.:'€ to each indiv1dualo When anx-

1.6 ty d6creased following pregnancy for 80 per~ent of the women! in

spite of an unchal1ged poor economic situation, Hirst and Strousse

con::luded that anx16ty .l,.s::harac:t.er~stic of th~ pregnancy period~

The women in a study by Kle1n y Potter, and Dyk (1950) were

all found to have anxiety at seme time during pregnancy, regardless

of whether the baby was wan, t.ed or unwan!;ed 0 Klein, Potter, and Dyk

(1950:') assumed that anxiety was common to all primiparae, and

suggested that it was .l,mperative for the medi.cal personnel to re

::Q.grtloZe the ~nevit.abilit:y of anxiety during pregnancy I and to be

sens it l"le to subtle or d1sgu~sed expressions of this anxiety.

Dav~.ds ~ DeVault. and Talmadge 1961) used a variety of psychc

l~gi:: 301 prc:sdures t>2 study emotional factors in women dur~ng preg

:r:a.nccy and follow~ng ch:l,ldbirth c Resul t.S en the Taylor Manifest

Anx1ety S::ale indi :::ated tha t anx~.ety decreased following pregnancy c

Bibring (1959" explained t..he st=:ess lonherent in pregnancy by suggest,

ing that endocrinological changes activate unconscious psychologi

cal resultso Psychosomatic symptoms are overt manifestations of

individual personality d:l,fficultiesc (B2bring! 1959)

In the Klein! Potter, and Dyk st.udy ~1950), anxiety was in

dl.cated .in primiparous pat.lcents by :l,nsomnia, depression, restless

ness" or uneasiness~ Kreger and Freed (1962c~ stated that symptoms

cf frustrati.on and overindulgence were common among women experienc

lng unplanned pregt'anciesc Anxiety seemed to be normally heightened

du.ring pregnancy :l,D a study by Newton U963) c It was estimated 26 that extreme resentment resulted in one out. of six conceptions being

termina t.ed by induced abortion 0 (Newton, 1963)

Rice (1964) suggested that some symptoms of basic emotional stress were the diffi.culty in adjusting to a prenatal diet and the delay in getting prenatal careo Kroger and Freed (1962) and Dick

Read (1968) all recognized the importance of physical att,ractive nesso Dick-Read said t.hat appearance, shape, and gait were matters of serious concern! no woman 1.iked the look of swollen ankles, stret::;h marks and blemished skino

Rosengren's study (1961) with 76 pregnant women was concerned wit.h the sick role of pregnancys Results indicated that women who defined their pregnancy as an illness tended t.o express many neg ative social aspirations and many desires for material acquisitions.

More women of low socioeconomic status regarded themselves as sick

than those of a hi.gher socioeconomic status 0

Colman (1969) listed emotional lability, anxiety, insomnia, and crying spells as common symptoms of pregnancYe He st,a ted that the shift in hormone level can produce strong behavioral effects, such as mood changes and an altered field of consciousness, which

may lead to overreactions 0

Anxieties during pregnancy have been categorized as: anxieties centering about the child, such as concern about deformity, injury, miscarriage; anxieties centering about the woman, for example, conce.rn about her health, death, delivery and paine Concern about the future was also felto Misconceptions about the physiology of

pregnancy, labor, and delivery created additional anxieties 0

(Klein, Potter, and Dyk, 1950) The pregnant woman coped by 27 repeated verbalization, the observance of rituals, identification with someone who had an uneventful pregnancy, and projection.

Pregnancy proved to be a catalyst for potential anxieties.

Toxem~a in pregnan~y has been studied by Coppen (l959)0 His comprehensive study involved matched pairs of toxemic and normal

subjects 0 Coppen found that the toxemic women had significantly less favorable attltudes toward sexual adJustment and pregnancy, and exhibited more psychiatric symptoms and experienced more emo tionally dl,sturbing events during pregnancys A study of 41 toxemic pregnant pat~ents showed that only 8 percent were found to have normal personalities as measured by the Minnesota ~ultiphasic

Personality :nventory. '(Ringrose, 1961) Ringrose (1961) implied that toxemia was a psychosomat.ic di.scrder of pregnancy.

Rosen C1955 " studied 54 women during their first trimester of pregnancy and concluded that the severity of nausea and vomiting

was commensurate with the degree of emotional stress 0 Ferrei.ra

~1969 however, observed that the question of emotional factors in nausea and vomiting was in doubto His review of research on the comp11cations of pregnancy discussed nausea, habitual abortion, lufertil.ity, prematur.l,ty, prolonged pregnancy, and tcxemia~ Grimm's study 1961) of habitual aborters, revealed that a pattern of poor emotion.al control, .:ompliance, dependency, and proneness to guilt fee.lings, was characteristl,c of these women,

In a study of emotional problems in pregnancy, Wenner et ale

(1969) suggested that. although pregnancy was a period of great emotional and psy::hological c:hange, motivation for success was uS-:Jlally high. The assumpt.ion that the desire for a child was of 28 central .:,rnportance was found to be inadequate In explain.lng the m';:)~.;~ ~.~a. tl.onal forcEs f:::r the pregnar:.c ies . The w'! ~ te:r s found that pregnan=y could represent an anXlOUS effort t= cope with loneliness, boredom, threatened abandonment, or ar:. ur:.::ertain self-image. W':>men wbo handled pregnancy well were motivated by natural gratification, whe~eas subjects with txc'wled pregnancl6s were highly mctivated by seclirl.tyc Th:"s st1.iJ.dy, :;..nvolving 52 maternity patients, indicated

~ha.j.. plax:ning see!l:'ed to have lit.tle. ::elationship to the ability ~o

hand.! e t.he pregnan;';y 0

PsYC.ho:ogloc:al stress may not. be equally harmful at all stages

~Rlcha~dson a~d Guttmachex, 1967~ In 1950, Klein,

Pot":e!:! a:nd Dyk rep:;rted that scme prospective mothers were upset by -:he stcr~9S cf mul<::.,.parct:s w::;men about difficultles and abn~rmal

~ t.ies Qf childbirth experien.::es, They also observed that anxieties

.J".[1.:re. ..3.sed as t,he e~d of pregr;,ancy approached" Pa tient.s expressed

W0St physi~al disccmfcr~ at th!s t~rne and reported feelings of

"going JLDtQ t,he unknown" ~ Dreams were most fre,quent.ly reported

during the last trimester 0

Caplan \1957) drew a parallel between the emotional manifesta t~ons of pregnancy and the hormcnal and general metabolic changes in the materni~y patient. In the first trimester, anxlety may be associated with l:',nhappiness and disappointment~ at. becoming pregnant.

Caplan (195; found that. primiparae hid their feelings and feared c~ndemnati:=:n if they admitted reject.ion .cf the.lr pregnancy.

In the middle of the second trimester, another common mani

fest,ation of pregnancy may be increased int,rover sion, passivi ty I and dependency? ~Caplan, 1957} Women who are insecure in their 29 feminine role may have special difficulties in accepting these

::hangesc Moad ~harrges may invite anger and rejec'tlon from c,:hers,

~lJSt at the s-tage when affection .LS needed 0 with the onset; ci

the ~.hi.rd trlomester I a shift occurs between a woman I s ego and her

{Caplan, 1957\ Old confl~cts and fantasies came ::'0 the surface, while normal defensive forces are bypassedc

R~ngrcse (1961: suggested that the greater ~ncrease in t~xemia as the end of pregnancy approached was perhaps due tc the in::reased d'lratlcon of the stress of pregnancy,c In Gri.mm IS 1961 study! results alsc !'.d:.c'at.ed that psy::hcl~g'lcal tensIon was greatest during Lhe

13s~ half of the last trimester 0 Finally, Carty (1970) fcund that the degree of dissat~sfa~tlcn with appearance seemed to ~ncrease as preg~a~cy prcgressed,

It has been suggested that grav~dity influences anxiety in pregnancy- K:ein, Fotter! and Dyk (1950) comrnenbsd that childb::rth

was myst~~r.~;::'.lS for pr.kIDclparaus pat.lents! and hence::aused stress c

In a later study! prl,XPloparGUS women were thought to be less appre-

be nsi ve thar~ mult"lparC11s women c (W~nokur and Werboff, 1956 The suggest.l.:J~. was made that perhaps the prim1parous pat.ients had no painful experien::~es or €'!ents to remember.

Cl.:LR1Cal impressions that maternal prenatal anxiety generally was inversely related to gravidi~y, led McDonald, Gynther, and

Chris!.:ak:::s (1963 to ma~ch their sa!D.ples according to gravid.!. ty c

Newton (1963' s'Jggest.ed t~hat women with no children were more likely to be pleased with the idea of pregnancyc In 1965, a study by Erickson showed t.hat primiparous women experienced more fears for themselves and the baby, yet showed less tens10n and irritability 30 than mUltiparous women. In conclusion, Illsley (1967) reported that obstetric risks were higher for primiparae of 30 years or over.

Studies published regarding anxiety and pregnancy can be divided into two broad categories, those concerning anxiety and obstetric difficulties, and those investigating anxiety and the development of the child. In one study of anxiety in pregnancy and childbirth, 27 primiparous women were studied in depth at pre natal clinic visits through interviews with a psychiatric social worker. (Klein, Potter, and Dyk, 1950) These women were classified as stable or unstable in terms of their personality organization.

It was concluded that the general pattern of behavior in pregnancy was consistent with this personality organization in most of the patients. Klein, Potter, and Dyk thus suggested that for the physically healthy primiparous woman, personality makeup may be a predictive clue to the kind of emotional and physiological adaptation made to pregnancy.

A complex research design by Zemlick (1952) tested the hypo thesis that anxiety, as it is measured by an attitude questionnaire, projective tests, and psychosomatic symptom inventory, could be used to predict the mother's adjustment during pregnancy and deli very. Although the sample was relatively small, results showed that those women with favorable attitudes early in pregnancy, were more apt to be well adjusted and to have less somatic complaints during pregnancy than women with unfavorable attitudes.

Grimm (1961) developed a research tool to measure tension in pregnancy. The aim was to identify those women who would be most likely to encounter obstetrical difficulties, in which emotional , 31 factors are important. Although the general level of psychological

tension remained fairly constant throughout the rest of pregnancy,

a greater number of women in the third trimester obtained scores

indicative of disturbance. Primiparae were found to have a some

what higher tension index than multiparae. Significant relation

ships were found between the higher tension index and the amount

of weight gained during pregnancy as well as the length of the

second stage of labor in multiparae. Grimm concluded that not all

women react the same way during pregnancy as variations in the

amount of tension present at various times during pregnancy were

indicated.

Davids, DeVault, and Talmadge (1961), using the Thematic

Apperception Test, reported a greater degree of alienation and sig

nificantly lower self-ratings on happiness in patients whose

pregnancies were complicated. Fifty women in the third trimester

of pregnancy, in a later study by Davids and DeVault (1962) were

assessed by a battery of psychological tests, including the Taylor

Manifest Anxiety Scale. Anxiety scores were also obtained from

self-ratings and ratings expected from others, a sentence completion

test, and the Thematic Apperception Test. Following childbirth,

the women were classified as normal or abnormal on the basis of

delivery room complications and childbirth abnormalities.

Analysis showed that the women Who experienced complications and

difficulties in childbirth, had been more anxious during pregnancy.

In a study designed to assess the role of anxiety in obstet

rical complications, McDonald, Gynther, and Christakos (1963) ad

ministered the IPAT Anxiety Scale to 86 pregnant women at the 32 beginning of the third trimester.· Patients were classified as normal or abnormal according to pregnancy, delivery-room, and postpartum records. The two groups were matched by age, intelligence, total pregnancies, and first pregnancies. Data from the standardized tests were scored independently of knowledge of the clinical data. The authors concluded that there was a positive relationship between anxiety and obstetric complications since the abnormal group scored significantly higher anxiety scores. Specifically, the abnormal group was found to have less ego strength, less self- sentiment development and more ergic tension and g~ilt proneness.

As well, total labor time and birth weight were positively correlated with anxiety. Furthermore, the mechanism by which the effects of anxiety were manifested physiologicallY was explored.

Reviewing these studies, Grimm (1967) concluded:

In general, both favourableness of attitude toward pregnancy and psychological comfort or stability have been demonstrated to have some relationship to emotion al adjustment and the occurrence of minor symptoms dur ing pregnancy. (Grimm, 1967, p.23)

No studies were found which investigated personality attributes of women before, during, and after pregnancy. liThe pregnant woman brings to the experience of labor all of her structural, physiologi-

cal and psychological assets and liabilities. II (Klein, Potter, and Dyk, 1950, p.56) Klein, Potter, and Dyk (1950) stressed the importance of the role of emotional factors because the physiology of labor is largely under the domination of the parasympathetic division of the nervous system.

Prenatal development is related to the psychological effects of a woman's pregnant condition on herself. (Sarason, 1966) 33

Sarason (1966) explained that mothers who differ in emotionality and in the psychological stresses experienced during pregnancy show differences in blood chemicals and differences in autonomic nervous system activity.

The IPAT Anxiety Scale was again used with pregnant women in a study by Ottinger and Simmons (1964). Nineteen subjects with extreme anxiety scores during gestation were tested during each trimester. Results indicated a positive relationship between high anxiety and the amount of neonatal crying, as measured on the second, third, and fourth day of life. After reviewing research studies relating state of pregnancy and the newborn child, Grimm

(1967) concluded that various kinds of maternal stress could in fluence the fetal environment, the fetus, and its birth.

Ferreira (1968) experimentally confirmed the importance of the mother's attitude during pregnancy on the infant's prenatal environment. He assigned scores on the degree of fear of harming the baby and the extent of pregnancy rejection to expectant women during the thirty-sixth week. Following birth, the babies were observed, and their behavior rated. Mothers of deviant babies were found to have had a significantly greater degree of fear of harming the baby during pregnancy.

Sontag (1941) believed that the central nervous system of the fetus could be affected by maternal stress. He demonstrated that there was a relationship between emotional disturbances in the third trimester and increased fetal activity. He concluded that the psychophysiological state of pregnant women exerted an influence upon the behavior pattern of the normal fetus. 34

According to Ringrose (1961) the stress of pregnancy is the

sum total of the fear of the unknown and environmental stresses.

Although Biskind (1958) believed that the fears and anxieties that accompany pregnancy could be offset by education, Ferreira (1969) believed that emotions may not be affected by logic. A statement by Grimm (1961) pointed to the difficulties involved in the investigation of anxiety and childbirth:

It is difficult to determine cause and effect with any degree of certainty ... it would be difficult to ascertain, for example, whether a woman is highly anx ious because she is expressing unpleasant physiological sensations, whether the symptoms are in vart caused by her continued state of anxiety, or whether both reactions are caused by a third factor such as endocrine imbalance. (Grimm, 1961, p.35)

Body-Image

Body-image refers to t,he body as a psychological experience.

It focuses on the individual's feelings and attitudes with his body and is concerned with the individual's subjective experiences with his body, and the manner in which he organizes them. (Fisher and

Cleveland, 1968)

Fisher and Cleveland (1968) suggested that an individual's body boundaries playa fundamental role in many aspects of behavior, and that to know the state of a person's boundaries enables someone to make meaninqful predictions about his behavior. A means of measuring boundary definiteness was devised by classifying responses to an inkblot series. Fisher and Cleveland's work involved intense experimentation relat.ing this Barrier index to psychosomatic behavior and social variations. From a review of the literature and the experimentation done in this area, the following is a summary: 35

1. "There is some evidence that the body scheme may function

as a basic standard or frame of reference which influences some of

the individual's modes of perception and also his ability to perform

certain skills. II (Fisher and Cleveland, 1968, p.50)

2. By and large, body-image has been defined as a psycholo-

g~cal variable - usually described as evolving gradually in the

course of a learning process in which the individual experiences his body in manifold situations and also notes the varied reactions

of others to it. (Fisher and Cleveland, 1968)

3. Techniques for studying body-image range from introspection,

informal observations, questionnaires, and the drawing of a persqn, to self-ratings.

In some subjects, Barrier score was found to be related to

certain patterns of behavior. Fisher and Cleveland's concept of self-steering behavior evolved from the construction of an ide~lized model of a high Barrier person. High Barrier score was related to a high level of goal-setting, a high need for task completion, low suggestibility, ability to express anger outwardly when frustrated, ability to tolerate stress and the degree of orientation toward self-expressiveness and self-gratification. (Fisher and Cleveland,

1968) Most of these characteristics involve obvious social and ego-involving behavior.

Adams and Caldwell (1963) postulated that body-image may be the core or center about which one tries to build up an ego structure. A study in 1965, conducted by Megargee, investigated the relation between Barrier scores and the agressive behavior of 75 juvenile delinquents. He concluded that the Barrier score was 36 both an index of adjustment, and an index of ego identity. Fisher and Cleveland (1968) reported that Barrier scores have been correlat ed with a number of psychosomatic conditions, severe neuroses and psychoses, family patterns, and cultural differences.

A second aspect of the body boundary concept is Penetration.

Fisher and Cleveland (1968) revealed that Penetration scores repre sented weakness, lack of substance, and penetrability of the body boundary. Penetration score is also obtained by classifying responses to an inkblot series. The authors felt that Penetration score was not the opposite equi~,i"alent. of the Barrier score. with normal groups they seemed unsure of its meaning, although the Penetration score was found to have meaningful application with certain special groups. (Fisher and Cleveland, 1968)

A study by McCcnnell and Daston (1961) confirmed the idea that the Barrier index manifests little relationship to indices that describe the actual structure or condition of the body. The body image boundary probably d~es not reflect the state of immediate situations, but it may be a means of maintaining homeostasis. Body image changes during pregnancy were investigated in 28 mUltiparous women. The Osgoog Semantic Differential and the Rorschach tests were administered during the eighth or ninth month of pregnancy and again three days after delivery. An interview was also con ducted during the third trimes~er. The Osgood Semantic Differential revealed higher evaluation of the body after delivery than during pregnancy. The authors implied that pregnancy was seen as an un natural condition by the subjects, with the body being misshapen, ugly, and devalued. A significant decrease in Penetration scores r 37

after delivery was explained by noting that an individual might

feel less integrated and more vulnerable during pregnancy. The

Barrier score did not change significantly. McConnell and Daston

(1961) concluded that the Barrier concept referred to slower chang-

ing aspectos of body-image, whereas the Penetration scores reflected

less stable characteristics of the body-image boundaries. Situation-

al factors threatening the ego could cause the shift in Penetration

scores.

It was also found in the McConnell and Daston (1961) study,

that positive attitudes toward pregnancy were related to positive

evaluation of the body guring that period. Those subjects with

positive attitudes/also had higher Barrier scores than those with

negative attitudes. P~S~l~~Y women with favorable attitudes em-

phasized the ability of their body walls to protect and contain

their young. It was concluded that attitude toward pregnancy could

be understood as a criterion of adjustment. (McConnell and Daston,

1961)

After interviewing 40 women in varying stages of pregnancy,

or in the immediate postpartum period, Carty (1970) concluded that

acceptance of changes in the body-image during pregnancy was vital .

.she observed that some prospective mothers were not happy at the

sight of their enlarged abdomen, while others could scarcely

wait for their abdomen to give visible evidence of advancing preg-

nancy. Carty (197 0) suggested that the latter show their maternal

pleasure by wearing maternity clothes before they really need to.

Perhaps the way a woman views herself could be a factor which de-

termines how she adapts to her new role. 38

Meyerowitz (1970) studied eight aspects of marital satisfaction

in relationship to experiences during first pregnancies. One index

measured satisfaction in terms of a woman's acceptance of body-image.

A negative body-image, which led to low self-esteem, was associated

with pregnancy dissatisfaction.

Differences in value orientation parallel differences in body-

image boundary definiteness. Testing 60 students, Appleby (1956)

found that subjects with high Barrier scores tended to score low

in theoretical values, as measured by the Allport-Vernon study of

Values. In the same study, a negative relationship was found be-

tween Barrier score and physical science interests on the Thurstone

Interest Schedule. A significant positive relationship existed

between Barrier score and humanitarian interests. It appears

that the more definite an individual's body-image boundaries,

the less likely he is to be interested in the physical sciences,

or t~o have a val ue orientation emphasizing the importance of

.J things and abstractions. The high Barrier person is more interested

in acti vi t.ies which focus upon cornmunica tion with other people,

about mat.ters th=i't are of emotional significance and ego-involving.

(Fisher and Cleveland, 1968) A similar study conducted by Fisher

and Cleveland (,1968) used the Morris-Jones Ways of Life form. The

results indicated that the higher Barrier subjects were different-

iated from the lower Barrier subjects not so much by their preference

for anyone way of life, as by their choice of a middle position

which accepts some aspects of a number of ways of life as good.

In the decade from 1958 to 1968 response to stress was studied

further, and findings indicated that the Barrier index is "an 39 excellent predictor of the ability to cope with actual or threatened damage of one's body". (Fisher and Cleveland, 1968, p.381)

This body-image index is also an indication of how an individual structures his relations with others. Groups of high Barrier indi viduals showed a pattern of equal participation, with a high regard for the importance of the individual. The low Barrier group structured personal relations. (Fisher and Cleveland, 1968) The process of socialization wherein one interacts with social figures, 1.5 bas:.::: to the boundary development. Fisher and Cleveland (1968) supported

Mead's theory of personality and self formation.

Fisher and Cleveland (1968) raised the question as to whether or not the body-image boundary encompassed the clothes one wears.

Kernaleguen (1968) found that being regarded as a fashion leader by one's peers related negatively to high Barrier scores. This research seemed to indicate that college women with weak boundaries sought fashionable clothes to reinforce and redefine weak boundaries.

Likewise, Compton (1964) in a study of psychotic women found a re lationship between low Barrier and preference for highly saturated colors. She hypothesized that low Bar:"rier individuals may re inforce boundaries by specific clothing variables.

In conclusion, the Barrier index seems to be an abstract measure of differentiation, a measure of how an individual experiences his body. From the knowledge of how a person has organized his perceptions of his body, one can discover some of his basic feelings about himself and consequently how he will conduct himself.

The body-image boundary does not mirror the actual properties of the body, rather, it represents attitudes projected onto the body.

(Fisher and Cleveland, 1968) 40

Clothing-Related Behavior

The necessity for understanding and predicting behavior re liably gave impetus to research and interest in the social and psychological interpretations of clothing-related behavior. Hartmann

(1949) was one of the first to suggest that clothing was a subject

for serious psychological study, saying that it could be of value

in understanding sociological concepts as well. He saw clothing as both a stimulus and a response. Treece (1959) hypothesized that

relevant behavioral concepts from the field of social psycho-

logy could be applied to the study of behavior relating to clothing, and that these concepts would be fundamental to an understanding of the function of clothing in behavior. Because clothing is a part of our material culture, it seems evident that an understand

ing of clothing-related behavior might lead to insight into the problems of individual adjustment and interpersonal relationships.

Self-concept is thought to be a controlling force in behavior.

This self-concept, a psychological construct, is defined as the sum of a person's appearance, background and origins, abilities, atti-

tudes, and feelings which serve to direct behavior. (LaBenne and

Greene, 1969) This self-concept is built up through accumulated experiences with others. Behavior is seen as an attempt to main

tain this organized concept of self. Because it indicates the most stable, important, and characteristic self-perceptions, psycho

logists consider the self-concept useful.

Clothing plays an important part in establishing this self-

concept. (Ryan, 1966) Although use of clothing in regard to the 41

self has been investigated by numerous authors such as Hall (1897),

Dearborn (1918), Harms (1938) , and Murphy (1966), further research

needs to be conducted for clarification. Just how clothing builds

or destroys one's self-concept is not clear.

The subjective aspect of personal appearance was considered by

Dearborn (19l8) when he reported that clothes help to protect us

from fear: fear of ridicule, fear of lack of taste, fear of lack

of self-respect and self-confidence, and fear of homeliness. Hurlock

(1929) discussed the relationship of clothing to the self:

We are apt to think of clothes as we do our bodies - they become perhaps more than any of our other possessions, a part of ourselves. It is impossible to disassociate our selves from this intimate part of our material possessions. We appropriate the admiration our clothes call forth, and this tends to enhance our self-esteem. (Hurlock, 1929, p.44)

Hartmann (1949) saw clothing as valuable only to the degree

that it extended, differentiated, or enhanced the wearer's self.

The self must become a better self with that particular piece of

clothing than wlthout it. Jersild (1952) mentioned that clothing

takes on subjective meaning if it is a means of proJecting or de-

fending the self in communication with others. In his study con-

cerning what young people liked about themselves, Jersild (1952)

called attention to the fact that a large number of the stUdents mentioned dress and grooming as an important part of what they

liked about themselves. A large amount of personal pride is In- valved in clothing the body, and this gives the observer an important

clue to the understanding of another's self-concept. At the same

time, however, Treece (1959) pointed out that dress cannot be expected to function with the same intensity for all individuals. 42

Clothing becomes closely identified with the body and becomes important in establishing self-awareness very early in life. (Hall,

1897) Garma (1949) and Schilder (1950) recognized a relationship of clothes to body scheme and personality:

Since clothes are a part of the body schema, they gain the same significance as parts of the body and can have the same symbolic significance as parts of the body. (Schilder, 1950, p.203)

An individual's attitude toward his somatic self may mirror important aspects of identity. Schild&r (1950) saw the function of clothes as transforming the body-image, and the full development of the personality was only possible through the medium of the body and the body-image. Sawrey and Telford (1971) suggested that because of the social evaluat.ions of one's physical make-up, the physical characteristics of one's body may indirectly influence self-concept" Although a person's physical self soon becomes un- important in itself, it may be significant because it determines how other people evaluate that person.

Clothing may function as an extension or enrichment of the self, by maklng the person a more important and attractive person.

(Flugel, 1969) Extensions of the self occur because a child discovers that his value in the eyes of others is partly a result of the values assigned to things extraneous to himself, such as clothing.

(Sawrey and Telford, 1971

Treece (1959) postulated that clothing may be used as an adaptive type of behavior to fulfill a need for self-regard by serving as a camouflage for one's true self-image. Calvin and

Holtzman (1953) studied 79 male students and concluded that the 43

tendency to enhance the self was inversely related to maladjustment.

The more poorly adjusted the individual, the more self-deprecativ€

he appeared 0 A h~ghly significant relationship between feelings

of clothing deprivation and lack of self-confidence was reported

by Vener and Hoffer (1959). Combs and Snygg (1959) also recognized

that the self could be enhanced through clothing. A study by Ryan

in 1966 showed that clothing is one of the means by which one strength-

ens self-esteemo College girls felt that knowing they were well

dressed in appropriate attire, enhanced their feeling of self-

confidence. (Ryan, 1966

In the past decade, numerous studies and dissertations have

attempted to study t.he relationship of clothing with self-concept,

in one of its var10US forms. (Deemer, 1967; Dickey, 1967; Klassen,

1967; Humphrey, Klassen, and Creekmore, 1971j Horn (1968) concluded

that. "clot--hing is a sign~f.icant fo.rce in the enhancement of the

self I and when llsed positively, contributes to one I s feelings of

self-acceptance, self-respect, and self-esteem". (Horn, 1968, polOl) Years before, Meiklejohn (1938 expressed similar thoughts:

Clothes are so 1ntimate, obvious and omnipresent a part of our personality that no other expenditure of equal amount can contribute so much to the satisfaction of our deep desire of personal recognition and to the sense of personal security always under threat in this un

cert,ain world. (Meiklejohn I 1938 I po 304

Clot.hing appears to be operat.ive also in the restoration of

feeli.ngs of self-worthc Goffman (1959) stated that the lack of

interest In personal appearance shown by the mentally disturbed person is an indication of loss of situational awareness and re-

jection of society. Fashion therapy is the term now used to r~•.

designate programs geared to help mentally ill patients improve

their physical appearance. (Thompson, 1962) This emphasis on

fashion therapy has emerged as a result of observing that as health

is regained, the individual tends to project an improved self-

image through the medium of clothing. Thus, personal appearance

is recognized as one of the clues to mental health. Compton's

work (1964) with psychotic patients, suggested that clothing

functions by strengthening or weakening the body-image boundary.

Those subjects with weak body boundaries seemed to reinforce their I.

body boundaries through their clothing fabric choiqes. Perhaps

those individuals with a high self-regard use clothing as a

means of self-expression while those with low self-esteem may use

clothing to cope with the social situation. So, an article of

dress becomes a means of communicating with the self. (Jersild, 1952)

Stone (1962 postulated tthat the self is established, main-

tained, and altered through co~munication. Social interactionists

describe the process of self formation as the internalization of

subjective evaluations of the attitudes of others. (Morris, 1962)

Secord and Backman (1964) stated that nonverbal cues operate when

situations involve minimal information, minimal interaction, and

the lack of a structured relationship. Clothing and appearance

are considered nonverbal cues in social transactions. Stone (1962)

declared that appearance was at least as important as discourse

in the establishment and maintenance of the self. Hall (1959)

included clothing as part of the "silent language" that is communi-

cated through the use of visual symbols. Horn (1968) suggested

that clothing serves to communicate to others impressions of one's 45

social status, occupation, role, self-confidence, and other person

ality characteristics.

Theories have been proposed regarding the function of cloth

ing in social situations, but there is little empirical research

to substantiate them. Machover (1949), using the Draw A Person

Test, found that individuals who overclothed the figures were super

ficially quite sociable and extroverted. She felt that a strong

desire for social approval rather than genuine interest in clothing

was the motivation. Ryan (1966) proposed that the individual who

is unsure of himself has low self-esteem, especially in social

situations, and will place more emphasis on the importance of clothes

than the individual who is self-assured socially. Douty (1963)

inquired into the part clothing plays in interactions. The person

ality and character one thinks his clothing portrays may be quite

different from what is perceived by others. (Douty, 1963)

Another communicative function of dress is that of role

identification, role assumption, and role performancee Flugel

(1969) declared that "clothes have entered into the very core of our existence as social beings". (Flugel, 1969, p.16) Murphy

(1966) observed that in most cultures physical appearance is a major factor in social acceptability, and usually is more important

for women than for men. "Clothes make the man - and especially the woman " (Murphy, 1966, p. 518)

Ryan (1966) explored the relationship between clothing and social roles further. Roles are the functions a person is expected to perform within society. These expected functions dictate accept able behavior. Clothing functions in the task of role identification r 46

because it is overt expression of role enactment. In fact, cloth-

ing may make the playing of a role easier. (Ryan, 1966) Wass

and Eicher (1964) affirmed this function in their study of teenage

girls.

Clothing facilitates role enactment by setting the stage for

a different type of behavior. The great emphasis placed on ap-

propriate costume is always evident in the theatre. (Horn, 1968)

Conflict often arises from the fact that an individual usually

occupies more than one role in society. The conflict here may

result in deviation from the expected norms of clotping behavior.

(Horn, 1968)

Clothing is of great importance for the pregnant woman be

cause it must accomodate the changing figure with the progressive

growth of the fetus. "Increasing size necessitates changes in

wardrobe, creates a typical posture of pregnancy, and finally makes

the heretofore simple process of tying shoes almost impossible. II

(Ingalls, 1967, p.80) Recommendations by physicians regarding

clothing refer to the utilitarian aspects of clothing - fit,

comfort, and support. The need for specially designed clothing

was discussed by Moomaw (1947). Groseclose (1958) investigated

the way in which the clothing needs of pregnant women were met

and reported that the needs varied with the resources available

in the situation of each individual. Kleh (1954), in a study

of buying practices among pregnant women, found that there was

great interest in personal appearance among pregnant women.

No report of studies pertaining to the selection of maternity

clothing with regard to the special psychological factors involved 47

in pregnancy has been found. Textbooks in the behavioral science aspects of clothing reveal this dearth of invest.igation. (Roach

and Eicher, 1965; Ryan, 1966; Horn, 1968) It seems possible that clothing could be an important environmental tool that the pregnant woman could use to assist in adjustment to the changes that ac company pregnancy. "We do find some evidence that interest ln clothing for the self is related to the type of adjustment the

subject makes to the environment." (Ryan, 1966, p.95)

Physicians see maternity wear as a possible morale booster, a way of creating positive attitudes. Dick-Read (1~50) emphasized the psychological importance of clothing during pregnancy. Well designed garments may save the expectant mother from embarrassment

and discomfort and enable her life to proceed in the manner to which she is accustomed. (Dick-Read, 1950) Daniels (1965) did

suggest that the self-awareness of the pregnant woman was related

to the selection of maternity clothing.

Does the pregnant woman perceive herself as performing an

important and relatively short role? Treece (1959) said that be cause pregnancy may be a "once only" experience, the pregnant woman has to look the part of the role she is performing. stone (1965~ proposed that role conflict might be manifested in an attempt to keep the condition of pregnancy secret through the use of constrict

ing garments.

Rubin (1967) observed that women often begin wearing maternity clothes long before physically necessary, perhaps because these garments are indicative of a desired change in status. Results of this study indicated that women who began wearing maternity garments 48 early in pregnancy expressed more positive attitudes about maternity wear. Rubin (1967) implied that primiparae who began wearing maternity clothing quite early in pregnancy were more anxious to assume the maternal role.

Results of Wilson's study (1968), with a sample of 100 married pregnant women, showed that women who began wearing maternity garments early in pregnancy expressed more positive attitudes about maternity wear than those who began wearing maternity garments later.

Wilson (1968) also found that expressed attitudes toward pregnancy and expressed attitudes toward maternity wear were. interdependent.

She implied that a lack of interest in maternity wear could be a clue to discontentment with other aspects of pregnancy.

Behaviors often observable in the use and choice of clothing may be classified as values. Values are thought to be central to a person's self-concept and resulting behavior. Jacob and Flink

(1962) defined values as "normative standards by which human beings are influenced in their choice among the alternative courses of action which they perceive". (Jacob and Flink, 1962, p.lO)

Parsons and Shils (1951) suggested that values act by narrowing the range of alternatives open, and by amplifying the consequences of various alternatives. Values are instigators of behavior.

Values influence judgments and actions by providing an abstract frame of reference for organizing experiences. (Robinson and

Shaver, 1969) John (1966) stated that the system of social values develops b~rough social interaction, with group values being in- ternalized. This internalization of values stabilizes the person's behavior and makes him internally more consistent. Combs and 49

Snygg (1959) suggested that when a person's values are known, it often becomes possible to make predictions about his behavior in certain situations. They concluded that a more adequate under standing of values is essential in order to arrive at a solution for human problems.

Horn (1968) maintained that values are a central motivating force in human action, and in clot.hing behavior. Through one's clothing choices, the individual reflects a set of beliefs about himself that he wants others to believe about him tOOe This process may occur consciously or unconsciously. (Horn, 1968)

Lapitsky (1961) developed a study based on the idea that because values give direction to actions, the investigation of values people hold in regard to clothing is important in an understanding of behavior. The study showed that general basic values were consistent with values concerning clothing. Divided on the basis of anxiety measures, the emotionally secure group scored significantly higher in aesthetic values, while those judged to be socially insecure placed greater emphasis on the social values of clothing.

Summary

Personality variables measured early in pregnancy have been found to relate to a woman's emotional adjustment and to the oc currence of physiological symptoms in later pregnancy, labor, and delivery. Therefore, to enhance maternal care, it is imperative to determine a woman's reaction and adjustment during a period of stress. Anxiety level is indicative of adjustment. 50

The concept of self provides a key to the understanding of

mental health. Theoretically, a person's body characteristics as

he perceives them, may exert a central influence on the development

and maintenance of this self-concept. Therefore, the feeling to wards one's body is a significant personality variable with mental

health implications. The body-image boundary concept has been

suggested as a measure of adjustment.

The review of literature points out three different measures

of adjustment, each of which operates at a different level of con

sciousness, within the individual. These are the gfineral level

of anxiety, attitudes and adjustment to pregnancy, and body-

image boundary.

Clothing is of intimate concern to the individual in terms

of his physical and psychological well-being. Inferred values of

clothing may offer insight and understanding of aspects of the

self, and hence may contribute to increased knowledge of

human behavior. The relationship between clothing and the

process of mental health needs clarification. r 51

CHAPTER III

METHODS AND PROCEDURE

This chapter is organized in the following manner: theoreti-

cal framework, hypotheses, definition of terms, selection of sample,

description of population, instruments, directional rating of

variables, test administration, and analyses of data~

Theoreti.cal Framework

The theoretical framework for this study, is based on the

work of Grimm who believed pregnancy to be a period of stress when

the homeostatic mechanisms of the body are disturbed~ Adjustment

to this stress is essential to mental health and is predictive of

the ease of delivery and outcome of pregnancy_ One index of this

adjust.ment is level of anxi.etYe Furthermore, this study is based

an theory and empirical resea.reh by Fisher and Cleveland who form-

ulated the body-image boundary concept 0 This subconscious evalua-

tion of the quality of body boundaries is also an index of adjust-

mente As mans' most proximate and personal environment, clothing

e;an contribute to adjustment by reinforcing body boundaries and

by serving as an extension of the self~ Value analysis is central

t.Q understanding and predicting behavior ~ The values pregnant

women seek to reinforce through clothing will provide insight as

to the function of clothing in adjustive behavior. , 52

Hypotheses

On the basis of the theoretical framework and the literature

pertinent to the problem, the following null hypotheses were drawn.

1. There will be no significant relationship between anxiety

level and the following variables:

a. seven factors in attitudes and adjustment to pregnancy.

b. body boundary (Barrier and Penetration).

c. four inferred values of clothing.

2. There will be no significant relationship between the seven

factors in attitudes and adjustment to pregnancy and the

following variables:

a. body boundary (Barrier and Penetration) .

b. four inferred values of clothing.

3. There will be no significant relationship between body

boundary (Barrier and Penetration) and the four inferred

values of clothing.

4. There will be no significant relationship between the two

aspects of body boundary, Barrier and Penetration.

5. There will be no significant difference among subjects in

each trimester of pregnancy in the following variables:

a. anxiety level.

b. seven factors in attitudes and adjustment to pregnancy.

c. body boundary (Barrier and Penetration).

d. four inferred values of clothing.

6. There will be no significant difference between primigravidae

and multigravidae in the following variables: 53

a. anxiety level.

b. seven factors in attitudes and adjustment to pregnancy.

c. body boundary (Barrier and Penetration).

d. four inferred values of clothing.

7. There will be no significant agreement in rank order of the

four inferred values of clothing:

a. among all subjects.

b. among subjects in each trimester of pregnancy.

c. between primigravidae and multigravidae.

Definition of Terms

Pregnancy is "the state of being with young or with child. The

normal duration of pregnancy in the human female is 280 days, or

10 lunar months, or 9 calendar months". (Fitzpatrick, Eastman,

and Reeder, 1966, p.606)

Trimester is "a period or term of three months". (Webster's New

World Dictionary, 1970, p. 1520) Hence, a normal pregnancy con;

sists of three trimesters.

Gravida is "a pregnant woman". (Fitzpatrick, Eastman, and Reeder,

1966, p.llS)

Primigravida (ae) is "a woman who is pregnant for the first

time" . (Fitzpatrick, Eastman, and Reeder, 1966, p.606)

Multigravida (~) is a woman experiencing a pregnancy other

than her first.

Primipara (ae) is "a woman who has given birth to her first

child" . (Fitzpatrick, Eastman, and Reeder, 1966, p.606)

Multipara (ae) is "a woman who has had 2 or more children". r 54

(Fitzpatrick, Eastman, and Reeder, 1966, p.115)

The usage of these four terms in the literature reviewed is

not consistent. For purposes of this study, the terms will be

used in their correct form as stated above.

Labor is "the physiological process by which the fetus is expelled

from the uterus at term". (Taber, 1958, p.L-l)

Fetus is "the child in utero after the third month of develop-

ment" . (Taber, 1958, p.F-13)

Delivery is "expulsion of the child at birth with placenta and

membranes from the mother". (Taber, 1958, p.D-9)

Parturition is the "act of giving birth to young". (Taber, 1958,

p.P-22)

Anxiety (Anx) is a measure of adjustment to stress. Cattell's anx

iety syndrome is a major second-order personality factor com

prising five expressions of sources: lack of self-sentiment develop

ment or failure to int.egrate behavior about an approved, conscious

self-sentiment, and socially-approved standards; ego weakness or

inability to control and express frustrative tensions in a suit

ably realistic way; suspiciousness, ranging from paranoid-type

insecurity; guilt proneness or feelings of unworthiness and de

pression; frustration tension, which is id pressure or the degree

to which anxiety is generated by excited drives and unsatisfied

needs of all kinds. (Cattell and Scheier, 1963) Operationally

defined, the level of general anxiety is the total score on the

40 items of the IPAT (Institute for Personality and Ability Testing,

Anxiety Scale Questionnaire, Self Analysis Form). possible range

of scores is from 0-80, and a high score is indicative of a high

level of anxiety. 55 stress is "any conditions impinging on the organism which require adjustive reactions". (Coleman, 1964, p.671)

Adjustive behavior is "behavior by which the individual attempts to deal with stress and meet his needs; also, effort to maintain harmonious relationships with the environment". (Coleman, 1964, p.656) coping behavior is required when one encounters stress and experiences tension. It involves actions that are purposive, to secure a balance of internal desires and needs with external de- rnands. (Nichols, 1971, p.3)

Attitudes and adjustment to pregnancy is an index of seven psychologically meaningful dimensions relating to pregnancy. The operational definition is the seven independent scores obtained on the

Grimm H.I.P. (Health Insurance Plan of Greater New York) Preg- nancy Questionnaire.

Psychological factors in attitudes and adjustment to pregnancy

Factor 1. (Neu) Neuroticism or relative lack of neuroticism;

range of scores from 0-66 obtained on 22 items; high score

represents low neuroticism.

Factor 2. (Lab) Attitudes toward labor and delivery; range

of scores from 0-24 obtained on 8 items; high score represents

positive attitudes.

Factor 3. (Des) Desire or lack of desire for pregnancy;

range of scores from 0-42 obtained on 13 items; high score

represents high desire.

Factor 4. (WoB) worry or lack of worry about the baby; range

of scores from 0-21 obtained on 7 items; high score represents

lack of worry. 56

Factor 5. (Sat) Satisfaction or dissatisfaction with the

husband and life in general; range of scores from 0-30 ob

tained on 10 items; high score represents satisfaction.

Factor 6. (D-I) Dependent - independent attitudes and the

extent to which one experiences oneself as "sick"; range

of scores from 0-42 obtained on 14 items; high score represents

independent attitudes.

Factor 7. (Som) Extent of somatic symptoms; range of scores

from 0-27 obtained on 7 items; high score represents few

somatic symptoms. (Grimm, 1968)

Body boundary is a personality dimension denoting how an individual experiences his body boundaries. (Fisher and Cleveland, 1968)

Barrier (Bar) is an index of the degree to which the individ-

ual regards his body exterior as a defensive barrier. Barrier

score is operationally defined as the number of times a Bar

rier response is given to the first 25 cards of the Holtzman

Inkblot Technique, Form A; theoretical score range from 0-25;

high score indicates high Barrier. (Fisher and Cleveland,

1968)

Penetration {Pen is an index of the degree to which the in

dividual regards his body boundaries as readily penetrable.

Penetration score is operationally defined as the number of

times a Penetration response is given to the first 25 cards

of the Holtzman Inkblot Technique, Form A; theoretical score

range from 0-25; high score indicates high Penetration.

(Fisher and Cleveland, 1968) 57 value is "a conception of the desirable which has a normative impact on behavior and is inferred from verbal statements and other behaviors" . (Kernaleguen, 1971)

Inferred Values of Clothing Inventory (IVCI) is a paper and pencil test designed by Kernaleguen (197l) to indicate strengths of four basic values which a person expresses through clothing choices.

The operational definition of each value is the score, obtained on 8 of the 48 statements designed to measure each respective value. The range of scores for each value is from 8-48.

Inferred values

1. Aesthetic (Aes) Seeking beauty and self-expression

through clothing.

2. Economic (Ec} Seeking maximization of resources through

clothing.

3. Comfort

a. Physical comfort (Comf-Phy) Seeking well-being of body

through clothing.

b. Psychic comfort (Comf-Psy) Seeking well-being of mind

through clothing.

4. Social

a. Social Acceptance (Soc-Ace) Seeking membership with

others through clothing.

b. Social Recognition (Soc-Rec) Seeking leadership

of others through clothing. (Kernaleguen, 1971) 58

Selection of Sample

The sample consisted of 56 pregnant women, of whom 42 were primigravidou's and 14 were multigravldouso The women were recruited

on a volunt,ary basis while in attendance at prenatal clinics c The prenatal service of the prov~ncial Department of Public Health provides a series af five or six orientation lectures by a nurse, for expectant mothers and fathers. These lectures cover such topics

as fetal de~Ielopment I nutri tlon, hygiene of pregnancy, preparatlon for pregnancy and post-delivery care, and the care and clothing of the babyc

In order to choose a representative sample of the Saskatchewan obstetric population, all prenatal cllnlcs being organized in southwest Saskatchewan, were visl-tedo A map is included in Appendix Co

The six test_ing centers were the ~:mly locations where the Department of Public Health had a reg~stration of at least three participants in each clinlc during the months of October and November, 1971,

The testing centers! Cabri! Eatonl.a, Gull Lake, Kindersley, Moose

Jaw, and Swift Current, provided sub] ect.s from urban, small town, and rural areas. The hour ar;d day of the classes varied in each center, as did the class structure. Table 1 gives a detailed

breakdown of ":.he chara:::terist ies of these clinics 0

In four of the six lo-:ations, the nurses had given advance notice of the testing, In two locat10ns the group test1ng was completed at the time of the first ViSlt. and a second visit was undertaken to ccmplete the indi vidually-administ.ered Holtzman Ink- blot Protocols, In one location ~ndividual sessions were scheduled following the gr~,up session, and on the following morning. In the """""._--'~

Table 1. Characteristics of six prenatal clinics in southwest Saskatchewan by location, time, attendance, and procedure followed

Number of Attendance Procedure Subjects Location Time Women of Husbands Followed Completing

. . 1. Cabri hospital afternoon 6 No d octor V1Slt, exer- 6 monthly classes cises, class, testing

Eatonia church evening 4 No testing only, class 4 weekly classes series completed in previous week

Gull Lake morning 8 No 3rd class, exercises, 6 hospital weekly classes class, testing

Kindersley afternoon 5 No testing only, class 5 hospital weekly classes series completed in previous week

Moose Jaw evening 27 Yes 1st class, testing 22 public health weekly classes followed introduction office to classes

Swift Current evening 14 Yes 3rd class, exercises, 14 public health weekly classes class, testing office l·one subject completed testing and was later disqualified due to incomplete Holtzman proto U1 col, leaving tot.al sample number at 56. "" 60

final three locations, both group and individual testing were

completed at one session. Because attendance was voluntary, and

fluctuated from session to session, an attempt was made to complete

the testing within a short period of time to avoid attrition of

numbers. Seven subjects were unable to complete the individual

testing due to the fact that convenient times could not be arranged.

No subjects refused to participate.

It was assumed that the subjects would be heterogeneous with

respect to age, income, occupat~on, and stage of pregnancy and con

sequently would be characteristic of the maternity ~opulation.

Attendance at the prenatal classes was free, voluntary, unrestricted,

and generally recommended by doctors for any of their maternity patients. Subjects who participated in the study were not paid.

Anonymity was guaranteed.

Permission was obtained from the Department of Public Health

in the Moose Jaw, Rosetown, and Swift Current regional offices to

attend classes under their sponsorship and to make a request for volunteers. SubJects were approached as a group, a brief explan

ation of the project was given, and an invitation was extended

for their participation. The precise explanation of the proJect

is reproduced in Appendix B.

Instruments

IPAT Anxiety Scale Questionnaire

The IPAT Anxiety Scale is designed to be a brief, non

stressful, and objective measure of general anxiety level. The

test is the product of large scale factor-analytic research by 61 cattell and his associates at the Institute for Personality and

Ability Testing. The 40 items were selected from the five scales of the l6PF test, also developed by Cattell from his work on person ality. The questions are distributed among the five components that measure anxiety sources: defective integration, lack of self sentiment; ego weakness, lack of ego strength; suspiciousness or paranoid insecurity; guilt proneness; frustration tension or id pressure. Of the 40 items, 20 are considered less subtle and pro vide an estimate of overt anxiety, the remaining 20 items measure covert or hidden anxiety. Each question has three alternative answers. A numerical score from O-SO is obtained, and this raw score may be converted into percentile scores for analysis and interpretation. (Cattell and Scheier, 1963

Construct validity was estimated at +.S5 to +.90 for the total scale. (Cattell and Scheier, 1963, p.7) Cattell and Scheier

(1963) claimed concrete validity for their scale, citing substantial correlations with physiological, behavioral, and laboratory tests of anxiety. Correlation between clinical consensus and the IPAT

Anxiety Scale scores range from +.30 to +.40. (Cattell and Scheier,

1963, p.S)

Reliability coefficients for the total anxiety score range from +.SO to +.93, depending on the type and nature of the group.

(Buros, 1965) Test-retest scores report reliability coefficients of +.S7 with a sample of Japanese students, and +.93 with male and female adults. Split-half reliabilities, indicating homogeneity are reported as +.S4 with 240 normal adults, and +.S3 with 200 male and female college students. (Cattell and Scheier, 1963, p.S) 62

Internal consiste~cy reliabilities for each of the five anxiety components are low, due to their brevity, and prudence is suggested in using these partial scores.

H.I.P. Pregnancy Questionnaire

The H.I.P.Pregnancy Questionnaire from the Health Insurance

Plan of Greater New York, was developed from data on normal emotion al reactions in pregnancy by Grimm and Venet (1966). It is a measure for assessing the emotional adjustment and attitudes of pregnant women, which can be applied in large scale research. The original sample consisted of 124 pregnant women, typical of the obstetric population, 20 percent primiparas and 80 percent multi- paras. (Grimm and Venet, 1966) The original 215 items in 17 subject matter areas, yielded a reliability coefficient of +.93 according to a modification of Kuder-Richardson formula, after administration to a pilot group of 58. Testing of this group was done before the 16th week of pregnancy. The validity of the questionnaire was enhanced by close correspondence between two independent measures derived from different assessment techniques.

Overall scores correlated +.42 and +.58 on two samples, indicating a fair amount of agreement between self reports and judgments based on a problem interview. (Grimm and Venet, 1966)

An item analysis was taken and the questionnaire revised on the basis of internal test criteria and item correlation with ratings. The best 78 items were selected and each was followed by four alternatives - definitely agree, more agree than disagree, more disagree than agree, definitely disagree. 63

Factor analysis of the revised questionnaire yielded seven psychologically meaningful dimensions, all of which could be easily identified:

Factor 1. Neuroticism or relative lack of neuroticism

Factor 2. Attitudes toward labor and delivery

Factor 3. Desire or lack of desire for pregnancy

Factor 4. Worry or lack of worry about the baby

Factor 5. satisfaction with the husband and life in general

Factor 6. Dependent-independent attitudes and the extent to

ll which one experiences oneself as II s ick

Factor 7. Extent of somatic symptoms.

All factors were scored in a positive direction, that is, a high score indicated a lack of neuroticism, positive attitudes, desire, lack of worry, high satisfaction, independent attitudes, and few somatic symptoms. There were few significant intercorrelations among the seven factors, indicating their relative independence

of each other. Reliability coefficients were: Factor 1. +.95, iii

PI I: Factor 2. +.87, Factor 3. +.97, Factor 4. +.93, Factor 5. +.96, iii: 'I" III' Factor 6. +.94, Factor 7. +.938 In late pregnancy, the questionnaire was again administered to the sample, and results indicated a high degree of consistency and stability of scores on all factors.

(Grimm and Venet, 1966)

The questionnaire thus proved to be composed of 7 fairly independent, highly reliable, easily identifiable emo tional and attitudinal dimensions and to correlate sig nificantly with expert judgements of the woman's psycho logical status. Grimm and Venet, 1966, p.39)

Permission to use the test and details regarding scoring were ob~ tained from Grimm. r

Body Boundary Index

The body boundary index was devised by Fisher and Cleveland

to measure the degree to which a person perceives his body boundaries

as firm and definite, or weak and indistinct. For this study, the

original Rorschach inkblots were replaced by the first 25 cards of

the Holtzman Inkblot Technique. Form A was used. The procedure as

outlined by Holtzman et ale was followed. (Holtzman et al., 1961,

p.29-33) The Holtzman Protocols were then sent to Fisher for

scoring.

The method of scoring the protocols for Barrier and Penetration

scores is outlined by Fisher and Cleveland (1968) in their studies

of body-image and personality. Responses receiving a Barrier score

would be those referring to any protective covering, membrane, shell

or skin, that might be symbolically related to perception of body-

image boundaries. These responses would include all separate articles

of clothing; animals or creatures whose skins are distinctive or un-

usual; references to enclosed openings in the earth; unusual animal

containers; overhanging or protective surfaces. In addition, a

Barrier score is given for references to things that are armoured,

covered, surrounded, or concealed; things with unusual container-like

shapes, and a few masks or buildings. The Barrier score is the total

number of Barrier responses given to the 25 cards. A score of one

is given each Barrier response. (Holtzman et al., 1961, p.74-77)

Similarly, the Penetration score is the total number of Pen-

etration responses given to the 25 cards, with a score of one given

for each Penetration response. Responses indicating that the body , 65 exterior is of little protective value would receive a Penetration

score. These responses would include images that involve the

penetration, disruption, or wearing away of the outer sprface of

things; images that emphasize modes or channels for getting into

the interior of things; images that involve the surface of things

being easily permeable or fragile. (Holtzman, 1961, p.77,78)

Reliability studies are reported indicating intra-scorer

reliability of +.90 for Barrier and +.89 for Penetration, and

inter-scorer reliability of +.84 for both Barrier and Penetration.

(Holtzman, 1961) Holtzman (1961) reported relatively low odd-even

reliability coefficients ranging from +.41 to +.68 for normal

samples. Results indicated that the intra-subject stability

of Penetration could fluctuate appreciably from one population

to another, with the standard errors showing considerable variability.

No statistics regarding validity of the Barrier and Penetration

aspects of body-image boundary have been reported by Holtzman.

Inferred Values of Clothing Inventory

Four approaches to the study of values have been outlined by

Adler (1956). First, values may be considered as absolutes exist

ing as external ideas. Second, values may be thought to inhere in

objects as the potential of those objects to satisfy wants and needs.

Tnird, values may be seen present in man as preferences held by

people. Finally, values may be conceptualized in terms of action.

(Robinson and Shaver, 1969, p.408)

Rokeach (1968) summarized the difference between values, at

titudes, and value system by stating that a value is a single belief r 66 which transcendentally guides actions and judgments across sPecific

objects and situations beyond immediate goals to more end states

of experience. A value is imperative to action, not only a belief

about preferable, but a preference for the preferable. (Lovejoy,

1950) A value is a standard or yardstick to guide actions, attitudes,

comparisons, evaluations, justifications of self and others.

(Rokeach, 1968) Hence, values differ from attitudes in being fewer

in number, more central and pervasive, less situation bound, and

more resistant to modification. Values influence judgments and

actions beyond an immediate or specific situation or goal by pro

viding an abstract frame of reference for perceiving and organizing

experiences and from which to choose~courses ·of .actiono (Robinson

and Shaver, 1969, p.lO) A person's value system represents a learn

ed organization of rules for making choices and for resolving con

flicts between two or more desirable modes of behavior or between

t,wo or more terminal states for which to strive. (Rokeach, 1968, p.17)

Catton (1954) offered specific demonstrations of three methods

of eliciting information about values: choosing between paired

alternatives, selecting the most infinite value, and rating values

according to ultimacy or importance. Values are assumed to be central

to the wayan individual structures his world and defines himself

and thus are not subject to experimental change.

For the Inferred Values of Clothing Inventory, the term value_

is defined as "a conception of the desirable which has a normative

impact on behavior and is inferred from verbal statements and

otner behaviors". (Kernaleguen, 1971) Four basic values were

culled from the literature and were assumed to be closely associated 67 with attributes of clothing which served as a means of attain- ing these goals.

1. Aesthetic - Seeking beauty and self-expression through clothing.

2. Economic - Seeking maximization of resources through clothing.

3. Comfort - a. Physical - Seeking wel~being of body through clothing.

b. Psychic - Seeking well-being of mind through clothing.

4. Social - a. Acceptance - Seeking membership with others through clothing.

b. Recognition - Seeking leadership of others through clothing. (Kernaleguen, 1971)

The inventory was devised as a pencil and paper test consisting of eight statements designed to measure each of aesthetics and economics. The comfort and social values were each subdivided into two categories, the former, physical and psychic, the latter, acceptance and recognition. Eight statements measure each of these subdivisions. The total inventory is composed of 48 statements to which the subject is asked to indicate to what degree each statement describes his feelings and actions, on a five-point scale.

Other behaviors often observable in the use and choice of clothing, such as conformity and modesty, were not classified as values since these were not assumed to be basic motives in clothing choices. Moreover, they tend to be situationally linked and hence do not fit the concept of value which implies relative 68

consistency and stability with time. Since values which determine human choices appear arrayed in a well defined order of precedence

or in hierarchical pattern, according to the magnitude of their

influence upon the given actor, the scores obtained for the four values may be arranged from highest to lowest to study an individual's pattern of values. This ordering does not necessarily apply to action in all kinds of situations, the relative priority of different determinants shifts when the actor confronts markedly different types of problems. The construction of this test is such that the scores for each value are mutually independent, thus avoiding the implication of ipsative scoring. The total inventory takes approximately 10 to 15 minutes for completion.

To date, only face validity has been established for the test. Reliability is currently being estimated. Item-total correlation coefficients for a group of college men and women (N=179) reported by Hiller and White are recorded in Table 2. Since norms are not available,lttere-total correlation coefficients for the IVCI were calculated for this study and are compared with those of Hiller and White (Table 2). All items for each value were significant at the .001 level with only four exceptions in the sample of pregnant women.

General Information Questionnaire

A general information questionnaire was devised to obtain background information about each subject. Questions concerned age, gravidity, trimester, planning of pregnancy, residence, amount of education, occupation and vvork status, and initial use of maternity apparel. (See Appendix A for the complete questionnaire.) r 69

Table 2~ Item-total intercorrelation matrix for four values of In ferred Values of Clothing Inventory with 56 pregnant women {Dowdeswell, 1971} and 179 college men and women (Hiller and White, 1971)

Value

Aesthetic Item 1 11 16 19 23 26 38 46 (N=56) D649 0788 0677 e571 ~ 572 .. 537 0701 ~610 (N~179) 0722 e591 0796 0674 e685 0578 .. 781 .,681

Economic Item 6 10 12 15 27 32 35 41 (N=56) .. 531 ~810 e754 0654 0528 0618 .539 .659 (N=179) 0543 ~616 e742 .. 661 0720 .451 .. 659 ,,599

Comfort ao Physical Item 8 18 30 34 36 42 47 48 ~N=56) 0385 0571 0384 .797 0705 ~596 ",575 .. 557 (N=179) .616 0679 0485 0551 .. 542 ,,578 ,,623 .643

bo Psychic Item 3 4 5 9 14 17 20 39 (N~56) 0459 0305 0618 0506 ,,592 0466 .,741 .576 (N=179) 0724 .. 590 0624 0503 0681 0712 ,,719 0620

Social ao Acceptance Item 2 13 21 24 31 37 43 45 (N=56) 0396 0621 0729 .662 0588 .. 526 0719 .663 (N=179) ,,558 0485 0596 .. 665 .706 ",583 ,,645 0587

bo Recognition Item 7 22 25 28 29 33 40 44 (N=56) 0667 0508 .. 747 .. 806 .. 670 .. 608 0517 .577 (N~179) 0541 .. 520 .,685 .664 .. 718 .698 0555 .. 607

r.995 (54df) = 0336 r.995 (177df)= .194 (N=56 ) - Dowdeswell, 1971, all correlations significant at ~001 level with 4 exceptions (N=179) - Hiller and White, 1971, all correlations significant at 0001 level r

Directional rating of variables

Table 3 gives the directional rating of all variables and

the possible ranges of scores. Each of the factors in the H.I.P.

Pregnancy Questionnaire, and each of the values in the IveI are

scored independently of the other factors and values.

Table 3. Directional rating of variables

possible Variable Range High Score Low Score

Anxiety (Cattell's IPAT Anxiety Scale) 0-80 high anxiety low anxiety

Attitudes and Adjust ment (Grimm's H.I.P. Pregnancy Questionnaire) Neu 0-66 low neuroticism neurotic Lab 0-24 favorable unfavorable attitudes attitudes Des 0-42 desire no desire WoB 0-21 lack of worry worry Sat 0-30 satisfaction dissatisfaction D-I 0-42 independence dependence Som 0-27 few somatic many somatic symptoms symptoms

Body boundary (Holtz man Inkblot Technique) Barrier 0-25 high Barrier low Barrier Penetration 0-25 high Penetra low Penetra tion tion

Values (Kernaleguen's IVeI) 6 values each value 8-40 high value low value 71

Test Adminlstrat~on

Testing was completed during the last two weeks of October and the first week in No-.;t61J1ber, 19'110 The following order was used in the admirdstration of tests: IPAT Anxlety Scale, H. I. P. Pregnancy

Questionnaire, IVCl! Ge~eral Informati.on Questionnaire, and the

HoI tzman Inkblot T6Chr:.ique c The f~xst four instruments were

administered to the ent~re g~:;;1.lp I while the Holtzman Inkblot Tech- nique was individually :adl:r,inistered at a time convenient for that slJbje~to SS7er: subje-::ts were unable to make a convenient appointment to cOI!1plete the test::,ngc The group administered tests required approximately 30 minuteso Testing locations were generally

free from nC'~se and d.l,e:t~~actL:;;:1 0 The nurses displayed a positive a tt,i tude ::owa.::d the test i"ng when explaLning the proj eet, and

::reated a fa",~o!:,a,b2-e atmosphere for' the testing. No subjects re-

r:xf wh;~:h l.\1'''iS l,a'ter disq'J.ali .fisd by Fisher dur:,ng the scc.I::ing of the Holtzman Inkblot Techniquec

Des~ript.ive

InfoYmation obtained from the general information questionnaire was ~odsd and freque~cy distributions were tabulated on this informati~rL '!'ablss sh:;;w ~hp Teax~ scores on all variables and the compar- iscn of mean scores wi,,:.h the established normsc

Statistical

Hypotheses la, Ib, and lOr 2a and 2b, 3, and 4 were analyzed using the Pearsonian prcduc-:,-moment ':;orrelation coefficient (r) r 72

wi t,h 54 degrees of freedom, to prov.i.de a measure of relationship

among variablesc Limits of +1~0 and -1.,0 represent perfect direct

relationship or inverse relationship, respectively 0 To determine

significance, the correlat.lon coefficients were compared to the

appropriate values .l.n a correlation table! N-2 degrees of freedom 0

Hypothesis 5a, 5b, Sc, and .5d was analyzed using a one-

way analysis of variance with 2,53 degrees of freedom [Ck-l) (n-ktl

Analysts of variance makes it possible to determine if there is a

significant, difference among subjects in each trimester of pregnancy

on anxiety 16ve1, attitudes and adjustment to pregnancy, body bound-

ary, and inferred values of clothing.

Hypothesis 6a, 6b, 6c, and 6d was also analyzed using a

one-way analysis of variance to indisate if there is a significant

difference between primigrav:idae and multigravidae on anxiety level~

attitudes and adJustment. to pregnancy, body boundary, and inferred

values of clothing.

HYPQthesis 7a, 7b, and 7c was tested using the coefficient

of concordance. tW) which represents the degree of agreement among

the o.rder of prefe.rence of ranked data 0 A highly significant coef-

ficient indicates a considerable communality of strengt,h of values

among subj ects c When perfect agreement. exists, W:;;l; when maximum

disagreement. exists, W~O 0 In this specific case, W represents the

community of agreement among the subjects on four inferred values

of clothing 0 The null hypothesis is tested using chi-square since

W is distributed approximately as chi-square. (Ostle, 1963)

For statistical results, levels of significance are: pc.IO -

highly significant; p<~05 - S.ign~ficant; p

RESULTS

This chapter will contain the results of the descriptive and

statistical analyses obtained on data from: IPAT Anxiety Scale,

H.I.P. Pregnancy Questionnaire, Holtzman Inkblot Technique, scored

for Barrier and Penetration, Inferred Values of Clothing Inventory,

and General Information Questionnaire. The descriptive analysis

is organized as follows: (1) general information from the question-

naire; (2) ranges, means, and standard deviations for all variables;

(3) comparison of means and standard deviations with established

norms. The statistical analysis is divided into three sections:

(1) results from the Pearsonian product-moment correlation; (2) re-

suIts from analyses of variance; (3) the coefficient of concordance

for rank order of values. Finally a statement pertaining to the

acceptance and/or rejection of hypotheses will be given.

Characteristics of the Sample

The General Information Questionnaire (Appendix A) yielded in-

formation on age, gravidity, trimester, pregnancy planned, res-

idence, amount of education, occupation, work status, husband's

occupation, and initial maternity clothing use. Table 4 gives the

frequency and percentage distribution of the above information.

Participants in the study included 56 married, pregnant women

in attendance at prenatal clinics in southwest Saskatchewan. In

selecting the sample, all 64 women registered at the six rural and 74 Table 4. Frequency and percentage distribution of 56 pregnant women by age, gravidity, trimester, pregnancy planned, residence, amount of education, occupation, work status, husband's occupation and initial maternity clothing use

Characteristic Frequency Percent (N=56 )

Age Under 20 6 10.71% 20-24 years 26 46.44% 25-29 years 20 35.71% 30-34 years 4 7.14% 35 or older 0 0.00%

Total 56 100.00%

Gravidity Primigravidae 42 75.00% Multigravidae 10 17.86% Multigravidae - miscarried 4 7.14%

Total 56 100.00%

Trimester First 8 14.28 % Second 33 58.93% Third 15 26.79%

Total 56 100.00%

Pregnancy planned Yes 44 78.57% No 12 21.43%

Total 56 100.00%

Residence City 32 57.14% Farm 12 21.43% Town 12 21.43%

Total 56 100.00% ,

75 Table 4. Continued.

Characteristic Frequency Percent (N=56 )

Amount of education 9 years 1 1.79% 10 years 3 5.36% 11 years 9 16.07% 12 years 13 23.22% 13 years 9 16.07% 14 years 7 12.50% 15 years 6 10.71% 16 years 6 10.71% 17 years 2 3.57%

Total 56 100.00%

occupation housewife 26 46.42% teacher 11 19.64% secretary 5 8.92% .:illil" nurse 2 3.56% ::II!' dietician 2 3.56% lab technician 1 1.79% I ~ II j iI medical records librarian 1 1.79% physiotherapist 1 1.79% biologist 1 1.79% social worker 1 1.79% sales clerk 1 1.79% teller 1 1.79% telephone operator 1 1.79% cook 1 1.79% waitress 1 1.79%

Total 56 100.00%

Work status Did not work during pregnancy 42 75.00% Workerl or planned to work to: montn 1 o 0.00% month 2 o 0.00% month 3 o 0.00% month 4 o 0.00% month 5 o 0.00% month 6 3 5.36% month 7 4 7.14% month 8 5 8.93% month 9 o 0.00% undecided 2 3.57%

Total 56 100.00% r 76

Table 4. Continued.

Characteristic Frequency Percent (N=56 )

Husband's occupation farmer 11 19.64% teacher 8 14.27% armed forces 6 10.70% mechanic 3 5.34% agrologist 2 3.57% clergyman 2 3.57% engineer 2 3.57% laborer 2 3.57% manager 2 3.57% salesman 2 3.57% truckdriver 2 3.57% accountant 1 1.79% banker 1 1.79% carman 1 1.79% firefighter 1 1.79% lab technician 1 1.79% lawyer 1 1.79% machinist 1 1.79% oilman 1 1.79% parts trainee 1 1.79% shipping clerk 1 1.79% steamer operator 1 1.79% student 1 1.79% sub foreman 1 1.79% telephone operator 1 1.79%

Total 56 100.00%

Initial maternity clothing use month 1 o 0.00% month 2 o 0.00% month 3 3 5.36% month 4 21 37.50% month 5 18 32.14 % month 6 11 19.64% month 7 3 5.36% month 8 o 0.00% month 9 o 0.00%

Total 56 100.00% 77 urban centers were contacted, and completed the group testing session.

Of these, seven women were unable to make arrangements for an individual testing appointment, and one woman completed the testing, but was later disqualified.

Table 4 gives a detailed breakdown of the sample. Of the total sample, 11 percent were under 20 years of age, 46 percent were between the ages of 20 and 24, 36 percent were between 25 and 29 years, and

7 percent were 30 to 34 years of age. Forty-two of the 56 women or

75 percent of the total sample were primigravidae. Of the remaining 14 multigravidae, four had previously been pregnant but had miscarried. Eight women were in the first trimester of their pregnancy, 33 were in the second trimester, and 15 were in the final trimester.

lit:': with respect to the planning of this pregnancy, 79 percent indicated that they had planned to have a child at this time, while

21 percent specified that the pregnancy had not been predetermined.

Cities, farms, and towns were all represented as residences. Fifty- seven percent lived in a city, 22 percent resided on farms, and 21 percent resided in a small town. The amount of formal education varied from 9 to 17 years. Twenty-three percent did not have a Grade

Twelve standing, 23 percent completed Grade Twelve but had no further training, and the remaining 54 percent pursued education beyond the

Grade Twelve level.

The occupations of the women and for their husbands were quite diversified. Forty-six percent of the women listed housewife as their occupation, 20 percent were teachers, 5 percent were secretaries, and the remaining 29 percent represented numerous r 78 occupations. Husbands' occupations showed still greater variation.

Twenty percent were farmers, 14 percent were teachers, and 11 percent

were armed forces personnel. Seventy-five percent of the women

did not work during this pregnancy, 5 percent, 7 percent, and 9 per-

cent worked or planned to work until their sixth, seventh, and eighth

month of pregnancy, respectively. Four percent indicated that they

would continue to work as long as they could, or until their health

necessitated a change. The month of initial maternity clothing use

varied from month three to month seven. Five percent began wearing

maternity garments in the third month of pregnancy~ 38 percent start-

ed in the fourth month, 32 percent started in the fifth month, 20

percent st,arted in the sixth month, and 5 percent did not begin wear-

ing maternity garments until the seventh month of pregnancy.

Ranges, Means, and Standard Deviations

The ranges of scores, means, and standard deviations for the

IPAT Anxiety Scale, HoI.P. Pregnancy Questionnaire, Barrier and

Penetration scores of the Holtzman Inkblot Technique, and the

Inferred Values of Clothing Inventory are recorded in Table 5.

Comparison with norms

The mean and standard deviation on the IPAT Anxiety Scale is

reported for 56 pregnant women, and these are compared to norms

published by Cattell (1963) for women. No norms specifically for

pregnant women were recorded by Cattell, but means and standard

deviations are reported for a group of pregnant women, classified

as normal and abnormal, by McDonald, Gynther, and Christakos (1963). 79 Table 5. Ranges of scores, means, and standard deviations for all variables for 56 pregnant women

standard Variable Range Mean Deviation (N=56) (N=56)

Anxiety (Cattell's IPAT) 7-58 31.982 10.372

Attitudes and Adjustment (Grimm's H.I.P. Factors) Neu 12-54 35.304 10.662 Lab 7-24 18.589 3.879 Des 20-40 32.411 4.107 WoB 0-21 11.839 5.144 Sat" 14-29 23.161 3.637 D-I 15-36 24.036 4.740 Sam 7-24 16.893 3.323

Body Boundary (Holtzman) Barrier 0-10 4.679 2.420 Penetration 0-14 3.214 2.585 'I ~:ill III!II Values (Kerna1eguen's IVCI) II 1. Aes 21-40 32.214 4.639 2. Ec 18-40 31.196 4.893 II 3. Comf-Phy 24-40 33.536 3.968 I: I ~ -Psy 18-39 290804 4.534 ~ 4. Soc-Ace 13-37 22.911 5.442

-Rec 13-33 22.357 5.206 I ~! "I' ~: r

Table 6 reports the means and standard deviations of the IPAT Anxiety

Scale for the group of pregnant women (1971), and for the women reported on by Cattell (1963), and the two groups of pregnant women investigated by McDonald, Gynther, and Christakos (1963). It is apparent that the mean anxiety level for pregnant women is slightly higher than for Cattellts sample of women, or for the pregnant women classified as normal in the 1963 sample. The reported standard deviations point to smaller variance from the mean in members of the

1971 sample. 80

Table 6. Comparison of means and standard deviations on IPAT Anxiety Scale Questionnaire

standard Group Mean Deviation

Dowdeswel1 (1971) Pregnant women, 31.982 10.372 Saskatchewan, average age range 20-24 years (N=56) cattell (1963) Women, average age 28.6 11.3 30 years (N~=405)

McDonald, Gynther, and Christakos (1963) Pregnant women, normal group (N~42 29.86 13.38 abnormal group (N~44) 40.09 8.07

Table 7 report s tohe means, ranges of scores, and standard deviations for each of the seven factors in Grimm's H.lcP. Pregnancy

Quest.ionnaire for the sample of 56 pregnant women, and those reported

by Gr lomID (1968;! 0 The 1971 group appear to be more neurotic, have more positive att.ltudes t,oward labor and delivery, have a greater desire for pregnancy, worry less about the baby, and are more satisfied and lndependent. S~me of these differences are only slight.

The ext,ent of somati~ symptoms for both groups is almost identical.

On the whole, subjects in the 1971 study appear to cluster about the mean while Grimm's subjects show greater var~ability.

Direct comparison of Barr~er and Penetration means with those of Holtzman et ale (1961) is impossible since the norms are based on

45 inkblot plates. Table 8 reports the means and standard deviations for Barrier and Penetration for pregnant women (1971) and for a group of average adults. (Holtzman et ale, 1961) As well, data from studies by Baer (1970), Fleming (1968), Kernaleguen (1968, 1970) , and 81 Table 7. Comparison of means, ranges of scores, and standard deviations on Grimmts H.I.P. Pregnancy Questionnaire

Dowdeswell (1971) N=56 Grimm (1968) N=124 Factor Mean Range S.D. Mean Range S.D.

Neu 35.3 12-54 10.7 36.2 9-60 10.0 Lab 18.6 7-24 3.9 16.0 2-24 4.6 Des 32.4 20-40 4.1 30.9 4-42 8.6 WoB 11.8 0-21 5.1 14.8 0-21 5.1 Sat 23.2 14-29 3.6 22.9 11-30 4.6 0-1 24.0 15-36 4.7 22.1 6-39 3.2 Som 16.9 7-24 3.3 16.1 6-24 3.2

Table 8. Comparison of means and standard deviations for Barrier and Penetration scored on Holtzman Inkblot Technique

Test Barrier Penetration Group Items Mean S.D. Mean S.D.

Oowdeswell (1971) 25 4.68 2.42 3.21 2.59 pregnant women, N=56

Holtzman (1961 ) 45 5.92 3.50 2.85 2.16 average adults, N=252

Baer U9 7 01 25 8.05 3,15 5.83 2.61 college women, N=102

Fleming (1968) 25 5.75 2.79 physically disabled women, N=20

Kernaleguen (1968) 25 7.61 3.4 college women, N=68

Kernaleguen (1970) 25 6.53 3.23 3.30 2.13 college women, N=40

Torreta (1968) 25 6.85 3.18 college women, N=27

All protocols scored by Fisher except those in samples of Holtzman and Baer 82 Torreta (1968) are included. The subjects in the studies by Baer

'~1970)! Kernaleguen (1968, 197 0), and Torreta (1968) were all female college students, while Fleming's (1968) subjects were women with physical disabilities, not all college educated, but of a similar age. Barrier score is considerably lower for pregnant women (1971), and variance within that group appears small. Very little data in volving Penetration scores are reported, although Penetration does appear to be lawer for this sample of pregnant women than for other weroen.

The Inferred Values of Clothing Inventory is ~n the process of being validated as a research instrument. No norms are avail.- able for comparison.

Pearsonian Product-Moment Correlation

Association among variables was analyzed using the Pearsonian correlation coefficient (r). This measure imposes limits of +1.0 and -1.0 which represent a perfect direct relationship or inverse

~elationship, respectively, among variables. The correlation coefficients (r) were compared to the appropriate values in a table of critical values of the Pearson r, to determine significance.

Table 9 is an intercorrelation matrix showing the correlation coefficients for all variables. This table reports that the level of anxiety correlated negatively with six of the seven factors in attitudes and adjustment to pregnancy, four of the factors being significant at the .001 level. The level of anxiety showed no correlation with Factor 5, satisfaction with husband and life in general, Barrier, or Penetration. A value for social acceptance Table 9" Intercor relation mat:.r'ix fo.r anxiety i H. Ie Po fact_ors, body boundary, and values on .56 pregnant women

fPAT H. I . P. Factors Bodl Boundarl r:-~I. Variables - Ani< Neu Lab Des WoB Sat D-I Som Bar Pen Aes Ec Comf-Phl Comf-Psl Soc-Ace Soc-Rec Anx 1.000 -.733*** -.384** -.303* -.572*** -.051 -.426*** -.436*** -.158 .099 -.058 -.257" -.108 .158 .274* .225 0 Neu 1.000 .332* .294* .405** -.069 .489*** -.483*** .148 .078 .219 0 .194 .052 .003 -.190 -.120 Lab 1.000 .378** .414** .110 .326* .459*** .Oll .033 -.077 .054 .020 -.237" -.171 -.422*** Des 1.000 .2470 .336* .204 .492*** -.233 0 -.005 -.093 .050 -.080 -.272* -.141 -.222 0 WoB 1.000 -.211 .319* .316* -.001 -.142 -.320* - .094 -.102 -.270* -.224 ° - .432*** Sat 1.000 -.002 .215 -.091 .2460 -.094 .123 - .209 -.067 -.177 .036 D-I 1.000 .330* .239 0 .093 -.014 -.156 -.126 .029 -.242 0 -.214 Som 1.000 .086 .041 .023 .215 .068 -.260* -.210 -.392** Bar 1.000 .313* .089 -.053 .155 .110 -.055 -.080 Pen 1.000 -.204 -.189 -.132 -.186 -.235 0 -.080 Aes 1.000 .556*** .598*** .471*** .207 .406** Ec 1.000 .640*** .310* .336* .253 0 Comf-Phy 1.000 .279* .181 .057 Comf -Psy 1.000 .524*** .443*** Soc-Ace 1.000 .595*** Soc-Rec 1.000

o p < .10 r .90 (54df) - .219 * p < .05 r .975 (54df) - .259 ** p < .01 r .995 (54df) = .337 *** p < .001 r .9995 (54df) - .422

co w

-~-.~~ ------=:- .. =~-~-~.-..-..---.~~~ 84 correlated positively with anxiety, at the .05 level, while the economic and social recognition values approached significance, wi t,h anxiety.

The factors in attitudes and adjustment to pregnancy showed many positive intercorrelations, although Factor 5, satisfaction, was more independent. Factor 3, desire, approached significance negatively with Barrier. while Factor 6, independent attitudes, approached significance positively with Barrier. Only one factor, satisfaction, showed an approaching significance with Penetration, this being posi ti ve . Worry about. the baby showed a . negative cor relation with four of the values, social recognition at the .001 level, psychic comfort and aesthetic at the .05 level, and social acceptance at the .10 levelo Attitudes to labor and delivery correlated negatively with social acceptance at the .001 level, and with psychic comfort at the .10 level. Desire was negatively related to psychic comfort at the .05 level and to social recogni tion at the .10 level. The extent of somatic symptoms showed a negative correlation at the .01 level with social recognition and a positive correlation at the .05 level with psychic comfort. Two correlations approached significance, neuroticism with aesthetic value positively, and independent attitudes with social acceptance, in a negative direction.

The two measures of body boundary, Barrier and Penetration, showed no siqnificant re.lat:'cr,ship ",r:. t:h ls.ve 1 of anxiety, factors in attitudes and adjustment to pregnancy, or the inferred values, although they did correlate positively with each other at the .05 level. Table 9 reports that the inferred values of clothing tended 85 to correlate positively with each other. The use of clothing for social acceptance showed a negatlve correlation with Penetra tion which approached significance.

Analyses of Variance

The first analysis of variance was a one-way ANOV. This was conducted to determine whether there were significant differences among the subjects in each trimester of pregnancy on level of anxiety, t.he seven factors in attitudes and adjustment to pregnancy, body boundary measures of Barrier and Penetration, and the four inferred values of clothing. A similar analysis of variance was performed to determine if there was a significant difference between primi gravidae and multigravidae on the same variables as listed above, anxiety level, attitudes and adjustment to pregnancy, body boundary, and inferred values of clothing.

Tabl'3 10 gives the results of the first analysis of variance.

This indicates a significant difference among subjects in each tri mester for Penetration score. Penetration score dropped in the second trimester, but rose sharply in women experiencing the third trimester. The difference was significant at the .01 level. The difference in desire for pregnancy among women in the three tri mesters was approaching significance. Desire for pregnancy was greatest for women in the second trimester, and lowest for women in the third trimester.

The second analysis of variance is reported in Table 11.

Differences between primigravidae and multigravidae, on all variables, were not significant. Difference in neuroticism approached sig nificance, indicating that primigravidae were less neurotic than others. Table 10" Analys is of Var,ianr:e C'ompa,r iog means for anx ie ty, H. I . P. factors, body boundary, and values by trimester of pregnancy

Treat.ment, Means Mean Squares Variable Trimester 1 Trimester 2 Trimester 3 Treatment Exp. ErroL F-Rat.io (N:oc:8 ) (N~33 ) (U=15) (2,53 df)

Anxiet,y 29.000 31.121 35.467 138.867 1060401 10305 H.I.P. Factors Neu 34.000 36.242 33.933 35.423 1160623 Oc304 Lab 170500 190091 18.067 100946 150201 o. 720 Des 33.000 33.212 300333 44.353 15.827 2.802 WoB 13.500 11.788 1.1.067 15.553 26.876 0.579 Sat 22.375 23.394 23.067 3.433 13.598 0.252 D-I 23.500 23.970 24.467 20613 23.221 0.113 Sam 16~500 16.819 17.267 1.757 11.393 00154 Body boundary Barrie,r 4.125 4.455 5.467 6.712 5.826 10152 Penetration 3.000 2.394 5.133 38.908 5.464 70120** Values Aes 31.875 320909 30.867 22.046 21.497 1.026 Ec 33.125 310121 30.333 20.558 24.070 0.854 Comf-Phy 350500 33.303 33.000 18.480 15.641 1.181 Comf-Psy 29.250 29.515 30.733 9.082 20.994 0.433

Soc-Ace 23 c 125 220788 23.067 0.615 30.704 0.020 Soc-Rec 22.750 22.030 22.867 4.327 22.966 0.155

"p .10 F .90 (2,53) 2.42 *p .05 F .95 (2,53) 3.17 **p <.01 F .99 (2,53) 5001 ***p <.001 F.999 (2,53 ) 8.01 OJ en TableLlo Analysis of Variance comparing means for anxiety, H.I.P. factors, body boundary, and values by gravidity

Treatment Means Hean Squa.res Vari;;)ble Primigravidaf> Multigyav.idae Treat.ment Expo Erro.t' F-Ratio (N~42 ) \N·~14 ) (1,54 df)

Anxiety 10"976 35.000 170.006 106.426 1,597 H.I.P. Par:-:tors Nell 36.810 30.786 381.006 108.719 3.504'; .Lab 18.571 18,.643 00054 15.324 0.003 Des 32.786 31.286 23.625 16,7.39 1.411 WoB 12.262 10.571 30.006 260399 1.137 Sat 230405 22.429 10.006 13.288 0.753 D-I 23.833 24.643 60881 22.760 00302 Som 17.09.5 16.286 6.881 11.120 0.619 Body Boundar:y Bar.rier 4.738 4.500 0.595 5.956 0.100 Penetrat.ion 30548 2.214 18.667 6.459 2.890·· Values Aes 32.000 32.857 7.714 21.772 00354 Be 31.048 31.643 3.720 24.317 0.153 Comf-Phy 33.262 340357 12.595 15.802 0.797 Comf-Psy 29.667 300214 3.149 200883 0.151 Soc-Ace 22.905 22.929 0.006 30.158 0.000 Soc-Rec 22.500 21.929 3.429 27.545 00124

"'p .10 F .90 (1,54) 2.83 *p ~ .05 F .95 (1,54) 4.02

OJ '-.I

-"--=---- -=---~- ---~=~~-----="...-=,,--=---- 88

Coefficient of Concordance

The coefficient of concordance (W) represents the degree of agreement among the order of preferences of ranked data. If W=l, perfect agreement exists, and if w=o maximum disagreement exists.

The null hypothesis is tested after W has been calculated, using

chi-square. (See Table l l~ I In this specific study, a highly significant coefficient of concordance indicates a considerable community of strength of values among subjects. (See Table 12,,)

Table 12 reports the rank order of values for the total group of 56 pregnant women. The values of social acceptance and social recogni"tion rank lowest on the scale, while the values for physical comfort and aesthetics are highest. Table 13 reports this ranked order of values among pregnant women to be highly significant at the .001 level.

The ~ank order of values for pregnant women in each trimester of pregnancy is reported in Table 14. The values remain similarly ordered, with physical comfort valued most, and social acceptance and social recognition valued least. However, a change in the order of values ranked second, third, and fourth, occurs among women

in each trimester. Women in the first trimester rated economic

and aesthetic values higher than psychic comfort. The women experienc

ing the second trimester rat.ed aesthetic second, and economic third.

For women in the third trimester of pregnancy, psychic comfort

superceded the aesthetic and economic values. The economic value

gradually dropped from second to fourt,h position. For each of the

trimesters, the rank order of values is highly significant at the .001

level. Table 16 reports that the rank order of values is identical

for primigravidae and multigravidae. 89

Table 12. Rank order of values on Inferred Values of Clothing Inventory for 56 pregnant women sum of ranks Rank order of values (N=56)

111.5 Comfort-Physical 135.5 Aesthetic 154.5 Economic 182.5 Comfort-Psychic 293.5 Social-Acceptance 298.5 Social-Recognition

Table 13. Significant agreement in rank order of values on Inferred Values of Clothing Inventory for 56 pregnant women

Analysis (N=56)

Coefficient of Concordance (W) .596 Chi-square (X2 ) 166.9 ***

2 ***p < .001 x .999 (5 df) 20.515 Table 14. Rank order of values on Inferred Values of Clothing Inventory by trimester for 56 pregnant women

Trimester 1 (N=8) Trimester 2 (N=33) Trimester 3 (N=15) Sum of Sum of Sum of ranks Rank order of values ranks Rank order of values ranks Rank order of values

13.5 Comfort-Physical 68.0 Comfort-Physical 30.0 Comfort-Physical 19.0 Economic 73.5 Aesthetic 40.5 Comfort-Psychic 21.0 Aesthetic 89.0 Economic 44.0 Aesthetic 30.5 Comfort-Psychic 111.5 Comfort-Psychic 46.5 Economic 39.5 Social-Acceptance 174.0 Social-Acceptance 77.0 Social-Recognition 44.5 Social-Recognition 177.0 Social-Recognition 80.0 Social-Acceptance

Table 15. Significant agreement in rank order of values on Inferred Values of Clothing Inventory by trimester for 56 pregnant women

Analysis Trimester 1 (N=8) Trimester 2 (N=33) Trimester 3 (N=15)

Coefficient of Concordance (W) .671 .627 .552 Chi-square (X2 ) 26.821*** 103.402*** 41.428***

***p < .001 x2 .999 (5 df) 20.515

w o

~ ___ -=-_~-O-~7_-~=-=-~~=~_~~_ 91

Table 16. Rank order of values on Inferred Values of Clothing Inventory by gravidity for 56 pregnant .women

·Primi2ravidae (N=42) Multigravidae (N=14) Sum of Sum of ranks Rank order of values ranks Rank order of values

86.5 Comfort-Physical 25.0 Comfort-Physical 103.0 Aesthetic 32.5 Aesthetic 113.5 Economic 41.0 Economic 135.0 Comfort-Psychic 47.5 Comfort-Psychic 221.0 Social-Acceptance 72.5 Social-Acceptance 223.0 Social-Recognition 75.5 Social-Recognition

Table 17. Significant agreement in rank order of values on Inferred Values of Clothing Inventory by gravidity for 56 pregnant women

Analysis Primigravidae Multigravidae (N=42) (N=14)

Coefficient of Concordance (W) .587 .633 Chi-square (x2 ) 123.228*** 44.265***

***p ,.001 x2 .999 (5df) = 20.515 92

Hypotheses and Results

The following seven null hypotheses were formulated:

1. There will be no significant relationship between anxiety

level and the following variables:

a. seven factors in attitudes and adjustment to pregnancy.

b. body boundary (Barrier and Penetration).

c. four inferred values of clothing.

A significant negative relationship was discerned between anxiety level and lack of neuroticism, attitudes toward labor and delivery, desire for pregnancy, lack of worry, independent attitudes, and few somatic symptoms. No relationship was confirmed between anxiety level and Factor 5, satisfaction. There was no significant relationship between anxiety level and either Barrier or Penetration.

One of the inferred values of clothing, social acceptance, was found to correlate positively with level of anxiety. Therefore,

Hypothesis la is rejected for all factors except Factor 5, Hypothesis

Ib is accepted, and Hypothesis lc is accepted, except for the social acceptance value.

2. There will be no significant relationship between the

seven factors in attitudes and adjustment to pregnancy

and the following variables:

a. body boundary (Barrier and Penetration).

b. four inferred values of clothing.

No significant correlations were found among any of the seven factors in attitudes and adjustment to pregnancy and Barrier or Penetration.

Factor 2, attitudes toward labor and delivery, correlated negatively with social recognition, while Factor 3, desire for pregnancy, 93 correlated negatively with psychic comfort. A significant negative correlation was found between Factor 4, worry about the baby and the aesthetic, psychic comfort, and social recognition values.

Finally, Factor 7, extent of somatic symptoms, displayed a sig nificant negative correlation with social recognition. Therefore,

Hypothesis 2a was accepted and Hypothesis 2b was rejected for the aesthetic, psychic comfort and social recognition values and accepted for the economic, physical comfort, and social acceptance values.

3. There will be no significant relationshi~ between body

boundary (Barrier and Penetration) and the four inferred

values of clothing.

Barrier and Penetration did not correlate significantly with any of the four inferred values of clothing. Therefore, Hypothesis

3 was accepted.

4. There will be no significant relationship between the

two aspec::ts of body boundary, Barrier and Penetration.

Barrier score correlated positively with Penetration score.

Therefore, Hypothesis 4 was rejected.

5. There will be no significant difference among subjects

in each trimester of pregnancy in the following variables:

a. anxiety level.

b. seven factors in attitudes and adjustment to pregnancy.

c. body boundary (Barrier and Penetration).

d. four inferred values of clothing.

There were significant differences among subjects in each trimester of pregnancy on Penetration scores. There were no significant 94 differences on anxiety level, the factors in attitudes and adjustment to pregnancy, Barrier, or the four inferred values of clothing. Therefore, Hypothesis Sa, Sb, and Sd were accepted while

Hypothesis 5c was rejected for Penetration of Boundary and accepted

for Barrier.

6. There will be no significant difference between primi-

gravidae and multigravidae in the following variables:

aD anxiety level.

b. seven factors in attitudes and adjustment to pregnancy.

c. body boundary (Barrier and Penetration).

d. four inferred values of clothing.

There were no signif1cant differences between primigravidae and multigravidae on any of the variables, anxiety level, seven factors

in attitudes and adJustment t.o pregnancy, body boundary, or four

i~ferred values of clothing. Therefore, Hypothesis 6 was accepted.

7 There will be no significant agreement in rank order

of the four inferred values of clothing:

a. among all subjects.

b. among subjects in each trimester of pregnancy_

~ between primigravidae and multigravidae.

A significant rank order of values was found for the subjects ln the total grcup, for subjects in each trimester of pregnancy, and for primigravidae and multigravidae. Therefore, Hypothesis 7 was reJected. 95

CHAPTER V

INTERPRETATION

The interpretation of the results from this investigation will be discussed in the light of the theoretical framework and the objectives delineated for this study. The theoretical framework stated that adjustment during pregnancy is essential for mental health. Consequently, a knowledge of how the pregnant woman adjusts may be predictive of the course and outcome of pregnancy_" A woman's level of anxiety, attitudes to pregnancy, and perception of her body boundaries are all diverse measures of adJustment. Clothing is viewed as an important factor in the maintenance of self, and as a communicative factor in social interaction. Clothing can thus function in the adjustment of the pregnant woman by reinforcing body boundaries. Because values are central to understanding and predicting behavior, inferred values of clothing will yield information about adjustive behavior, and the functions of clothing to that person.

The theoretical framework resulted in the formulation of three main objectives for the present research study. The first objective was the investigation of the pregnant woman's adjustment through an examination of a variety of indices of adjustment, and their interrelationship. These measures were level of anxiety, attitudes toward pregnancy, and body-image boundary (Barrier and

Penetration). A second objective was to examine the values pregnant women have with respect to clothing and to determine if these 96 values are significantly ordered, and related to the measures of adjustment. Finally, the comparison of women in each trimester, and the comparison of primigravidae with multigravidae on the measures of adjustment and the inferred values of clothing, was a third objective.

It was assumed that a sample of pregnant women in attendance at prenatal classes would be typical of the general obstetric population, although a higher proportion of primigravidae was expected.

Studies by Donny and Reid (1960), Yankauer et ale (1960), and Reeder and Reeder ~1965j, suggested that clinics attract faIJlilies of particular educational and sociceconomic level. An investigation of a woman's motivation to attend childbearing classes might reveal characteristics that are typical of this person in contrast with characteristics of the pregnant woman who does not attend classes.

Curiosity, a desire for knowledge, anxiety, or advice from family, friends, or doctor, could serve as motives for attendance. If clinics attract anxious women, it might be expected that the analysis of this group might not then be characteristic of the general maternity population.

The General Information Questionnaire attempted to further de- fine the pregnant women who attend these prenatal clinics. As expected, the questionnaire revealed that the sample was composed largely of primigrav~dae. In 19:1, the Canadian Dominion Bureau of

Statistics reported that 34.2 percent of pregnant women were bearing their first child, 27.8 percent were bearing their second child,

16 percent were bearing a third child, and 21.9 percent were having a fourth or later child. The larger number of primigravidae would 97 seem to indicate that curiosity and desire for knowledge are primary motivations to participate in prenatal classes among women pregnant for the first time. The fact that 59 percent of the women in attend ance were experiencing the. second trimester of pregnancy is not sur prising, as this is the period when the certainty of pregnancy has been established, and general well-being is characteristic. It would appear that the high percentage (79 percent) of women report ing this pregnancy as planned, might be indicative of corresponding ly positive attit.udes toward pregnancy_ However, the fact that the pregnancy was planned is not necessarily synonymous with a desire for pregnancy.

The composition of the sample proved to be heterogeneous with respect to maternal age and residence. The Dominion Bureau of

Statistics reported tn 1971 than in Canada, 8.7 percent of children were born to mothers under 20 years of age, 34.8 percent were born to mothers aged 20 to 24, 29.5 percent born to mothers aged 25 to

29, 15.8 percent born to mothers aged 30 to 34, and 11.1 percent were born to mothers 35 years or older. The average age of a mother was 27.1 years. The women in this sample appear to be younger than the pregnant women of the national population, in

1968. The research design employed subjects at six locations to achieve heterogeneity. The 1966 Census (Dominion Bureau of Statistics,

1971) reported residence figures for Saskatchewan as follows: 49 percent of the population lived in urban areas, 21.7 percent lived in non-farm rural areas, and 29.3 percent lived on farms. This sample of pregnant women appears to follow a residence pattern typi cal of the entire provincial population. 98 The observation that 54 percent of the subjects had pursued

educat,ion beyond the Grade Twelve level, and 77 percent had completed

Grade Twelve is in accordance with findings from previous studies.

(Yankauer et al., 1960; Reeder and Reeder, 1964) Women attending

prenatal classes have been found to have a high educational level.

The large percentage of women listing housewife as their occupation

suggested that the clarity of the examining statement be questioned.

It is possible that women perceived their occupation as temporary

and applicable only while they were actually working. The large percentage of women unemployed during pregnancy coul.d be interpreted

in terms of ~osengren's theory (1961), to mean that pregnant women

view themselves in a "sick" role. The data regarding work status

also suggest the prevalence of traditional childbearing attitudes

which encourage the pregnant woman to remain at home during pregnancy.

(Goshen-Gottstein, 1966)

The first wearing of maternity clothing varied from the third

to the seventh month of pregnancy, with 38 percent of women commenc

ing to wear maternity clothing in the fourth month, 32 percent in

the fifth month, and 20 percent. in the sixth month. These findings

are consistent with the suggestion that according to actual figure

changes and consumer opinion, maternity outerwear is not needed

until the fourth or fifth lunar month 0 (Tate and Glisson, 1961)

The first obJective of this research was to investigate the

adjustment of pregnant women through an examination of a variety of

indices of adjustment with respect to different levels of physio

logical and psycho-physiological integration. The IPAT Anxiety

Scale was employed as a general measure of anxiety. Considering 99

the total scores reported, the raw score mean of 32 for pregnant

women is higher than the raw score mean of 28.6 reported by Cattell

and Scheier (1963) for a general population of women. This is to

be expected on the basis of pregnancy studies by Bibring (1959)

and others, (Kroger and Freed, 1962), which suggest that pregnant women experience intense emotional disequilibrium without basic

deterioration. The norms reported by McDonald, Gynther, and

Christakos (1963) for a group of "normal" pregnant women on the same

IPAT Anxiety Scale, are also slightly lower than the anxiety score

reported for this sample. Perhaps this difference.can be explained

in terms of the nine year time span. Doctors claim that, in general,

we are becoming a more anxious population. (Chapman, 1972) A second

interpretation is also possible. If women attending prenatal classes

are motivated by anxiety, then the difference in anxiety levels might be due to the fact that the women in the 1963 sample were not

drawn from prenatal classes.

The H.I.P. Pregnancy Questionnaire was designed as an index of

adjustment specifically for pregnant women. In comparison with the

women in Grimm's 1968 study, pregnant women in 1971 were slightly more neurotic, had more positive attitudes to labor and delivery,

and had a greater desire for pregnancy. They worried less about the

baby, were slightly more satisfied with husband and life in general,

and were more independent. The extent of reported somatic symptoms

for the current sample remained at a level similar to that of the

1968 study. Grimm's sample (1968) showed much greater variability

in desire for pregnancy. The fact that means and standard deviations

in this study (1971) were similar to those established by Grimm (1968) 100 lends reliability to this questionnaire as a measure of adjustment in pregnant women, Medical advances and education could be respons ible for the increasingly positive attitudes toward labor and de livery and decreased worry about the baby. The wide use of contra ceptives could have an effect in producing more positive attitudes, satisfaction, and desire for pregnancy by enabling women to become pregnant when they want to be. Greater independence could be a function of the increased emancipation of women, as evidenced by coverage given this topic by the mass media in the 70's. Increased neuroticism is consistent with the above average an~iety level, as anxiety, as defined by Cattell (1963) is one feature of neurosis.

However, such gross variables as neuroticism or anxiety may not be as significant a predictor of adjustment during pregnancy as more subtle, differentiated va.riables which may be components of anxiety and neuroticism. (Grimm and Venet, 1966)

The body-image is the woman's organizat.ion of subjective bodily experiences, and as such, can influence her behavior and total adjustment. This concept was an indication of adjustment in this sample of pregnant women. Lower Barrier and Penetration scores as measured by the Holtzman Inkblot Technique are reported for preg nant women (1971) as compared with other norms. Although Fisher and Cleveland (1968) state that Barrier score does not reflect the actual structural characteristics of the body, women may see their bodies as less clearly defined during pregnancy, perhaps due to constant change, hence the Barrier score is lower than the norms.

An hypothesis could be formulated regarding any shift in Barrier score that might occur before, during, and after a woman's pregnancy. 101 On the other hand, the Penetration of Boundary score is thought to be more sensitive in immediate situational conditions, and a change in score during pregnancy could be expected. When conditions occur which have significant disturbing effects upon the bodily system, tpese effects seem to be reflected very quickly in how the body is experienced. (Fisher and Cleveland, 1968) The McConnell and

Daston study of 1961 examined pregnant women during pregnancy and after parturition. Although they reported a Penetration score higher than the Barrier score, their interpretation of the Barrier and

Penetration scores is consistent with the reasoning e~aborated above.

Fisher and Cleveland (1968) postulated that high but similar Barrier and Penetration scores might indicate empathic ability.

A second objective delineated for this study was to examine the values pregnant women rank order with respect to clothing, and to determine the relationship of these values with the measures of adjustment. At this time, no norms are available for comparison.

A second step in the investigation of the measures of adjustment was an analysis of the association among these variables, using the Pearsonian correlation coefficient.

The level of anxiety, as measured by the IPAT Anxiety Scale correlated negatively with six of the seven factors in Grimm's

(1966) conception of attitudes and adjustment to pregnancy. High anxiety was related to neuroticism at the .001 level, indicating that the two characteristics being measured are tapping the same sources. In the literature reviewed, the terms anxiety and neuro ticism were often used interchangeably. High anxiety level was also shown to be related to the expression of many somatic symptoms, 102 dependent attitudes, and worry about the baby, at the .001 level.

Negative attitudes toward labor and delivery and lack of desire for pregnancy showed .a relationship with anxiety at the .01 and .05 levels respectively. It seems likely that anxiety during pregnancy may represent a larger syndrome of which the factors reported by Grimm are simply components. No relationship was established between anxiety level and satisfaction with the husband and life in general.

This would support the findings of Bibring (1959), who suggested that the anxiety typical of pregnancy is something different fr.om a permanent personality disorder.

Two positive correlations between anxiety and the inferred values of clothing were reported. A high level of anxiety was associated with the social acceptance value at the .05 level, and with social recognition at the .10 level. Social respectfulness and protection would seem to give the pregnant woman a more secure feeling. Perlman (1968) stated that when pregnancy is a socially expected and desirable condition, the woman feels affirmed.

Approaching significance, a negative correlation was noted between anxiety and the economic value. Perhaps those who display high anx iety are anxious because they are attempting to maximize their resources in the form of money, time, and energy.

I:n 19.68., Grimm reported only four intercorrelations at the .01 significance level among the seven factors of the H.I.P.Pregnancy

Questionnaire. The present study disclosed 15 intercorrelations.

Relative lack of neuroticism was associated with few reported somatic symptoms and independent attitudes at the .001 level, with lack of worry about the baby at the .01 level, and with positive 103 attitudes and desire for pregnancy at the .05 level. These findings seem to indicate that the woman who is better adjusted tends to be more enthusiastic about the pregnancy. Grimm and Venet 11966) ~e ported similar relationships between lack of neuroticism and the desire for pregnancy, and few somatic symptoms. In view of the finding that neuroticism was not related to any of the remaining factors, Grimm and Venet (1966) concluded that women who are most concerned about labor and delivery, or about the health of the baby, are incorrectly labelled as neurotic. The present study, however, showed that neu roticism correlated with all but one of the seven faQtors. With in creased medical technology, a decrease in worry about labor and de livery, and about the baby, would be expected. If these worries still persist, the underlying reason could be general anxiety and consequently a relationship between anxiety and these factors could be expected.

Relationship was identified between positive attitudes toward labor and delivery and few reported somatic symptoms at the .001 level, both desire for pregnancy and lack of worry about the baby at the .01 significance level, and independent attitudes at the

.05 level. This would support Rosengren's hypothesis (1961) that those who think of themselves as "sick" during pregnancy would be concerned about labor and delivery" Grimm and Venet (1966) reported a positive correlation between positive attitudes to labor and delivery and independent attitudes.

Factor 3, the desire for pregnancy, correlated with all of the factors in attitudes and adjustment to pregnancy with the exception of independent attitudes. Few somatic symptoms related to desire at the .001 level, while satisfaction and lack of worry correlated 104 with desire at the .05 level and the .10 level respectively. Grimm and Venet (1966) interpreted this finding to mean that those with the strongest desire for pregnancy were the most satisfied. These re sults are also consistent with the recent study of marital satisfact ion in primiparous couples by Meyerowitz (1970). Lack of worry about the baby correlated significantly at the .05 level with independent attitudes and few somatic symptoms, while independent attitudes and few somatic symptoms correlated with each other at the .05 level.

These results point to the picture of a well-adjusted pregnant woman.

Satisfaction with husband and life in general showed a 4 relationship with only one factor, the desire for pregnancy. This result was explained by Grimm and Venet (1966) by suggesting that satisfaction seemed to be concerned with environmental comfort whereas the other factors like neuroticism were concerned with intrapsychic comfort.

Perhaps a confounding effect of gravidity, maternal age, prior pregnancy experiences, education, and the prenatal class itself could tend to obscure some of the correlations which might be expected. The intercorrelation of Grimm's factors might indicate that the instrument is measuring an overall factor such as adjustment.

The two aspects of body-image boundary, Barrier and Penetra tion, showed few obvious relationships with any of the variables.

However, Barrier and Penetration intercorrelated positively at the

.05 level of significance. Although Fisher and Cleveland (1968) reported that this intercorrelation only occurred when the number of responses the subject gives to the inkblot plates is not restricted to one response, one other study reported a similar intercorrelation. 105

The U-500 research project reported a positive correlation signifi cant at the .05 level between Barrier and Penetration for 30 college men, and for a second group of 30 college women. (Kernaleguen,

1970) These findings would definitely support Fisher and Cleveland's hypothesis (1968) that Barrier and Penetration are not opposite extremes of the body-image continuum. Perhaps pregnancy causes the woman to focus upon her body with such concern and preoccupa tion that ambivalent attitudes are expressed. During pregnancy the projection of one's own personality into an object such as the growing embryo, could result in simultaneous definition of one's body boundaries as firm and also easily penetrated. This concept of em pathy needs to be examined further in its relationship to body-image.

The hypothesis that self-steering behavior is related to high

Barrier was supported by a positive correlation between Barrier and independent attitudes at the .10 level, independent attitudes being a major characteristic of self-steering behavior. Low Barrier was associated with desire for pregnancy at the ~10 levele If the low Barrier person is easily persuaded by attitudes of the group, pregnancy might be desired if it is held in esteem by that group.

Persuasibility is thought to be characteristic of low Barrier people.

Penetration was related to two variables, the value for social acceptance, and satisfaction with the husband and life in general. These correlations were approaching significance. The individual who expresses great satisfaction with husband and life in general seems to experience her body boundaries as vulnerable.

Perhaps satisfaction is a function of interdependence in a relation ship. A corollary follows that competitive self-steering women with a 106 high Barr~er may not requlre the feeling of satisfaction with a

tration score was asS'cc::at.ed with a low value for social acceptance~

If "':,he person wi.th hi.gh Penetration empathizes with others, she would be c~ncerned more wl.:~:h understandi.ng another rather than with being a::::::epted by ar,other ~ Boundary development. is explained in

terms cf an ir::teractlon wi t.h signlficant social figures 0 (Fisher

and Cleveland, 1968; It is possJLble that few significant correlations between the body-image bQur:~dary measures and the other indices of adJustment and ~lalues were uncovered because the body-image

II 80ncept is an abstract one, r:)perat.1ng at. a subconscious level c :1 'I I Fisher ar:d Clevela.'1d (1968: suggested that the boundary could be

conceptual.Lzed as playing a,11 ~mpQrtar.:t role len maintaining homeo-

stasis < In th.LS role 5 the level of adJust.ment. as measured by other

indi~es a~d the expresslc!;: c·f one's values, may be disguised 0

An ~nves~:.gati:>!i ·;)f the i.nfer:=ed valUeS of clothing revealed

a number cf irt.ercQrrelatior;;s among the values" The fact that the aesthetic value ::~rrelated s ig:;ificar~tly with four values, and show-

ed a trend t:;ward c~rrelatir.g with social acceptance, may be par-

tially explained by examl,ning the definition of aesthetic valuec

Self-expressicr: Q"~ seeking ~ndi vidual~ ty through clothing appears

to be a factor .lcnhsJ:"8X),t in ether 1,val"les, as well as aesthetic 0 The person valuing max~mizati:;;n1, of resources may choose to show self-

expression and i.~dr,.ri.duali ty in self-made clothing 0

The correlati(~n between EH::onomic and physical comfort values was highly signlfi::ant at the cOOl levelc Perhaps maximization of

time and energy :c,s re!.ated to clothing that is i~omfortable and 107 suitable for many occasions. The economic value was positively re

lated at the .05 level with psychic comfort and social acceptance, and at the .10 level with social recognition. The person seeking psychic comfort, social acceptance, and/or social recognition, per haJ;>s achieves these by stressj '!? m. !{;_mizat-.i':"'ln of one' s r~sour ~ ~s.

The value for physical comfort displayed a positive relationship with the value for psychic comfort, at the .05 level. The fact that one is physically comfortable in clothing should lessen one's awareness of clothing amd free cognitive mechanisms for other problems.

Further use of the IveI with different populations might reveal that the emphasis on physical comfort is a cultural trend, rather than a value specifically related to pregnancy.

Positive affiliation was shown between psychic comfort and all other values. Well-being of mind seems to be related to maximi zation of resources, self-expression, physical comfort, and one's relationships with people in social interaction. It is thus hypo thesized that the person who Jelues psychic cnmfort is aware of the influences of clothing on herself, and uses clothing for the rein forcement of many values.

The high level of positive correlation between social accept ance and social recognition indicates that these two measures may be tapping some of the same value components. The use of clothing in a social context may be a significant value in itself, regardless of the specific social motivation. The intercorrelations among inferred values suggest that clothing-related behavior may be a func tion of all the inferred values. However, clothing may not function with the same intensity and expression in all individuals. (Treece, 108

1959) Also, the function of the inferred values may not be the same in all individuals.

Four of the inferred values of clothing exhibited a significant relationship with some of the seven factors in attitudes and adjust ment to pregnancy. High aesthetic value correlated with worry about the baby at the .05 level. Perhaps the changing shape and proportion of the woman would serve as a constant reminder of the child, particularly if the changing shape was not viewed as pleasing.

The relationship between aesthetic value and lack of neuroticism approached significance. Perhaps the anxious person is not free to express oneself and to reveal aesthetic concerns. The economic value showed no significant correlation with adjustment. Pregnancy may be a time when maximization of time and energy is not important to the woman, perhaps due to health restrictions.

The value for physical comfort did not correlate significantly with the adjustment factors. This would indicate that most of Grimm's factors tapped a psychological rather than a physical level. A high value for psychic comfort was related to lack of desire, worry, and the reporting of somatic symptoms at the .05 level, and to negative attitudes for labor and delivery at the .10 level. It is to be expected that well-being of mind would be associated with pos itive attitudes toward pregnancy and adjustment to pregnancy.

A relationship approaching significance was found between worry about the baby, dependent attitudes, and social acceptance.

Social recognition was related to negative attitudes to labor and delivery and worry about the baby at the .001 level, to many som atic symptoms at the .01 level, and it approached significance with 109

the la:::;k of desl"re for pregnancyo Choosing clothing for social valu,es is associated with the anxious person who displays negative

attitudes and poor adjustment to pregnancy v The pregnant woman

appears to require social support 0

The comparison of pregnant women by trimester and by gravidity,

on the measures of adjustment and ~nfeI:red values of clothing, was

accomplished by two arHilyses: of variance 0 In the first analysis a highly sign~ficant difference for the Penetration score, among

subjects in ea:::h tr':'meste.r was found 0 The Penetration scores drop

ped.for wamen in the s90cnd trimester, and showed a sharp increase

for women in the third trimester 0 Th~s finding is consistent with

the work of McCoI:,nel1 and Daston (1961) who postulated that fantasies of boundary disruption :Tiight arise as the mother anticipates the

actual penetratior:, of body bou.ndaries dluing the bi,rth process 0

The shift in Penetratkon scores might be a function of situational

factors, whereas the Barrier score, reflecting mere basic and stable

characterlstlcs, does not sh~ft significantlYe The difference among women in each trimester in desJLre fer the pregnancy approached sig

nificanceo Desire appeared tc be lowest ~n the third trimester 0

The finality of the pregnancy, and the length of time could cause

this at ti t,ude c

The second analysis of variance comparing primigravidae and multigravidae revealed no s::'gnificant differences in any of the

variables 0 The difference i.n neuroticism approached significance,

wi th the pri,migravidcus w(~men being less neurotic 0 This finding would appear to lend support to a suggestion at the beginning of

this chapter! that the worner: att,ending prenatal classes during their 110 second pregnancy could be motivated by anx~etyo Grimm and Venet

(1966;: also found that primiparae were no mere anxious or concerned about pregnancy or del~very than multiparae~

The coefficient ~f c:;ncordan::e indicated a si.gnificant. agree- me~t in rank order of inferred values of clothing among members of the total groupo The st,:tonger values were for physical comfort, aesthetic; and 6Gonomic clothing, and psychic comfort, while the least prepotent values were for social acceptance and social reccg- nitiono Usi,ng Kernaleguen~s (1971) definitions of these terms, the pregnant women appear to seek~ (1) physical well-being through their

clothing, for exa."nple t clothing that allows freedom of movement, is

non-irritat1ng p possesses safety features, and is functional; (2) beauty and self-expression through::lcthing, for example, clothing that is s~itable but is also pleaslng to lock at; (3) maximization

of resources through clothing H fer example, ~lothing that is econe:m-

ical to buy or maks H and that takes. I1ttle time and energy l,n care and upkeep; (4y psychological well-being through clothing, for example! clcthing that is ::;>onslstent w.l,th ideas of modesty, that

builds self-'~:JJnfiden:;;:e! and all~ws sensitivlty to moods 0

These women place a low value on seekl,ng social interaction,

either leadership or membership through their clothing 0 Their clothing would net need to conform to the dress of others, and would not be chosen in order to gain acceptance, recognition, or praise from other peopleo It would appear t.hat childbearing receives

strong normative support fr,om society 0 The pregnant woman may not need tc reinforce the values of social aGceptance and rec.ognition

through her clothing if she is socially self-assured 0 Whether this

ii I I '!I I III is typical of the pregnant woman or simply a cultural trend could be investigated by the use of the IveI on different populat.ions.

Clothing may not be as important a factor in role identification for the pregnant woman as for people in general, due to the obvious

physiological changes t,hat occur during pregnancy 0 These results are consistent with the findings of Lap~tsky (1961) indicating that aesthetic and economic values were most important in her sample of adult womeno Preliminary studies with the Inferred Values of

Clothing Inventory indicate that the aesthetic value was ranked first in groups of coLlege students at the University of Alberta and utah State UnLversityo (Hiller and White, 1971; Kernaleguen, 1971)

The coefficient of concordance was alsc employed in analyzing the rank order of values among women In E'..:),:h trimester of pregnancy"

A signif:icant agreement. in rank order of val ue.s among the members of each of the trimester gr~upings was indi:;ated~ The rank orders were similar in that phys~cal comfort was valued most by women in all three trimesters! while soc~.al a-;;:ceptance and social recognition were valued leasto However, the middle three values changed in order in each t:rimesterc Women 6xper:lencing the first trim6ster of pregnancy placed e:::onomic and aesthetic values above psychic comfort, while women in the second trimester interchanged the

aesthet~ic and econom.i~ values 0 DurL1g the third trimester, the inferred value of psychic -Gomfort was more important than the

aesthetl~c or ec<::momic 0 The emphasis on economic value orientation, particularly at the begi.nning of pregnancy may be due to the re alization and awareness of the ~ncreased cost of living aheado

As bodl,ly changes become vis.ible I 1 t seems likely that aesthetics 112 would be more important to the pregnant woman during the second trimester. The third trimester seems to involve disequilibrium.

The increasing value placed on psychic comfort, is understandable.

Perhaps clothing is being chosen to suit the changing moods, or to make one feel better.

The rank order of values in primigravidae and multigravidae was highly significant. For both groups, the relative order of the values remained the same as the order expressed by the total group. All findings would seem to indicate that primigravidae and multigravidae who attend prenatal classes are very similar in their adjustment, and in their inferred values of clothing. 113

CHAPTER VI

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

Summary

The purpose of this research was to investigate the adjustive

behavior of pregnant women, and to examine the values they ~eek to

reinforce through clothing. Various indices of adjustment were

employed: level of anxiety, attitudes and adjustment to pregnancy,

and the body-image boundary index.

The theoretical framework underlying this study is based on

Grimm's conception of pregnancy as a period of stress and her belief

that knowledge of a woman's adjustment during pregnancy may be predictive of the course and outcome of pregnancy. Attitudes toward pregnancy and anxiety levels can be seen as measures of adjustment.

Furthermore, the theory and empirical research of Fisher and Cleve

land provide a third measure of adjustment, the body-image boundary

concept. This subjective evaluation of one's body boundaries has potential for predicting a wide range of behaviors. Finally, the

interdisciplinary approach to the study of clothing suggests that

clothing serves as an extension of the self by reinforcing body boundaries, and plays a communicative role in human interaction.

The values pregnant women seek to reinforce through clothing will provide information about their adjustive behavior.

The first. objective was to assess a sample of pregnant women on the measures of adjustment and to identify relationships among 114 these indices. The adjustment measures were: anxiety level, as measured by Cattell's IPAT Anxiety Scale; attitudes and adjustment to pregnancy, as measured by Grimm's H.I.P. Pregnancy Questionnaire; body-image boundary, both Barrier and Penetration, as measured by the Holtzman Inkblot Technique. A second objective was to determine the values of pregnant women in regard to clothing and to determine if these values are related to any of the indices of adjustment.

Pregnant women attending prenatal classes at six locations in southwest Saskatchewan were approached. All clinics in the area operative at this time, and with an enrollment of at least three women, were attended. Fifty-six women completed the group administered instruments: the IPAT Anxiety Scale, H.I.P. Pregnancy Question- naire, Inferred Values of Clothing Inventory, and a General Infor- mation Questionnaire. The Holtzman Inkblot Technique was administered individually at a later time. The protocols were sent to Fisher for scoring. The testing took place during the last two weeks of

October and the first week of November, 1971.

The sample of pregnant women reported a higher mean anxiety level than the norms established by Cattell with a general population of women. A comparison of the mean scores for the pregnant women with those established by Grimm in 1968, on the H.I.P. Preg- nancy Questionnaire, indicated that the sample members of the present study were slightly more neurotic, had more positive attitudes toward labor and delivery, had a greater desire for preg~ nancy, worried less about the baby, and were more satisfied and independent. The extent of somatic symptoms for both groups was almost identical. Mean score for Barrier of the pregnant women 115 was GOEsidsrably l~wer':.han the ncx:ros Establ~shed by Holtzman with

average. 3dlJl"~s 1 ac:' :.::JJw~r ~hap d':ly other norms inve.stiga-:ed cn a

va2'iety ~f popula1:: ~):1:S < PenstIat~cn of Boundary score was slightly higher i;han t.hat. I~po.tt.sd by Hcltzrr,ar;,~ although a direct. comparison

Ls l~mpcssi.ble 8.:.::1'";6 the H::;ltzm~r:. r::::'rms are based on 45 inkblot

plates Ii whlle the p.rese:nt~ study used 25 l!1kblct plates. Physical

~~mfcrt., aesthe~i~, Acor:::'mi=, and psychic ==mfort values were rated

The rest;::' ~g f.rcw ~~he General Info~ITlatlon Questionnaire as to

age.! resider.:e ~ gra"t~d: ty! t.r imes"":er J hi.:leband! S occl)paticn! and

Hcw-

C:Ci,?sr! :9'/~.. ~ ,:,£ edl:.::'3,tL~n was high. ,a~.d only few women worked dur-

Th~ sample was 75 percent primigravid::'.::.s, with 59 pe:rcent of ::.he ws:rr.€T EXper.let:'.:l"'i.q 1;.~he se:::cnd trimester cf

pregnar'.cy 0 The a ',werage age ra'1.ge was 20 t.::- 24 years J

All stat~st~=al analyses were dc~e at the Utah state Univer- s~ty Computer Ce~tey high le~}'el. cf a:rx~e·ty was associated wi ch high 'l.'alu6 being placed

also aSEoc~ated w~th neurot~oismc Negative attitudes to labor

and del:;;..very ~ 21 t-tle desire f,or pregnan·cy If worry about the baby, depe:lden~ attit:ldes, and the reporting of many somatic symptoms

all correlated wiot:h a high level of anxiety 0 The factors in at

~itudes and adjustmert t.Q p.Isgnancy intercorrelated positivelyo

The lnfe.rred 'r,~al~J\es cf clcth:tng also tended to' correlate posi tively 116 with each other. A high value for aesthetics was correlated with

worry about the baby, and neuroticism, while a high psychic comfort

value was associated with negative attitudes toward labor and de

livery, lack of desire, worry about the baby, and the reporting of

many somatic symptoms. The social values of acceptance and recog

nition both showed a relationship with worry about the baby, while

a relationship was identified between social acceptance and depend

ent attitudes and between social recognition and negative attitudes

toward labor and delivery, lack of desire, and the reporting of

many somatic symptoms. The Barrier and Penetration of Boundary

scores showed few relationships with any of the variables, but they

did relate positively to one another. The relationship between

Barrier and independent attitudes, and lack of desire for pregnancy,

approached significance. Penetration was positively related to

satisfaction with husband and life in general and was negatively

related to the value of social acceptance, approaching significance.

A third objective resulted in two analyses of variance being

conducted to compare women by trimester and by gravidity on the

various measures of adjustment and inferred values of clothing.

The first analysis revealed that Penetration score was significantly

different among women in each trimester, with the score at its

highest in the third trimester. Desire for pregnancy in each tri

mester differed, with desire being lowest in the third trimester.

This difference approached significance at the .10 level. A com parison of primigravidae and multigravidae revealed no significant

differences on any variables. The difference in neuroticism approached

significance with primigravidae being less neurotic than multigravidaeo 117

The results of the coefficient of concordance indicated a significant rank order of values with the values for physical com fort, aesthetic, economic, and psychic comfort taking precedence over the values of social acceptance and social recognition, This rank order rema~ned similar for primigravidae and multigravidae, but the order was found to change slightly ln the placing of the middle values, with women ~n each trimester,

The hypothesis that there would be no significant relationshlp between anxlety and: (a) the seven factors ln attitudes and adjust ment to pregnancy, (b) body boundary (Barrier and Penetration), and

~ four inferred values of clothing, was rejected for SLX of the factors in attitudes and adjustment, and for the economic, soclal accepta~~e, and soclal recognition valuesc No relationship was fou~d be+:ween ar,xiety and body boundary, nor with three of the in ferred values of clothing, aesthetic, physlcal comfort, and pSy~hl~ comf-::rtc

The s6c:;cnd hypothesis stating no s.~gnif icant relationsh,1p bet,ween the factors in attitudes and adjustment to pregnancy and:

ta; b~dy boundary ~Ba~rieL and Penetration) was reJected for Bar

Tley with desire for pregnancy, and independent attitudes, and fez

Penetration with satisfaction with husband and life in general, and was accepted for the remaining factors; (b) four inferred values of clo~hlrg was rejected for neuroticlsm wlth aesthetic value; for werry wi t,h aesthetic, psychic comfort! and the social values; for attitudes to labor and delivery! desire and extent of somatlc symp toms with psychic comfort and social recognitlon; and for dependent attitudes with social acceptance. Hypothesis 2(b) was accepted for the econcm~c and physical comfort values. 118

The hypothesis that there would be no significant relation ship between body boundary and the four inferred values of clothing was accepted except for Penetration with social acceptance. Barrier and Penetration of Boundary scores did not correlate significantly with any of the four inferred values of clothing.

The hypothesis stating that there would be no significant relationship between the two aspects of body boundary was rejected.

Barrier and Penetration of Boundary scores correlated positively with each other.

The hypothesis that there would be no significant difference among subjects in each trimester in: (a) anxiety level, (b) seven factors in attitudes and adjustment to pregnancy, (c) body boundary

(Barrier and Penetration), Cd) four inferred values of clothing, was accepted. Hypothesis 5 (b) was rejected for desire for pregnancy and Hypot.hesis 5 (c) was rejected for Penetration of Boundary scores.

The hypothesis which stated no significant difference between primigravidae and multigravidae in: (a) anxiety level, (b) seven factors in attitudes and adjustment to pregnancy, (c) body boundary

(Barrier and Penetration), and (d) four inferred values of clothing, was accepted, although certain trends toward differentiation were noticed in neuroticism and Penetration.

The last hypothesis that there would be no significant agreement in rank order of values: (a) among subjects, (b) among subjects in each trimester of pregnancy, and (c) between primigravidae and multigravidae was strongly rejected. There was a very signifi~ cant rank order of values for all pregnant women, either primi gravidae or multigravidae, and for women within each trimester. 119

The theoretical framework received some support. Comparison with established norms showed pregnant women to have a slightly higher level of anxiety than the normal female population, and this measure of adjustment was related to the index of attitudes and adjustment to pregnancy. The relationship of these adjustment measures with the more subconscious concept of body-image boundary, however, was not clearly established. The inferred values of cloth ing did yield information about the adjustive behavior of the preg nant woman, as a highly significant rank order of values was revealed.

The objectives delineated for this study were fulfilled.

Several recommendations for further research were developed from the findings.

Conclusions

1< Pregnant women in this sample expressed a distinct value orient

ation with regard to their clothing. This should have

marketing implications for the ready-to-wear industry.

2. Body-image appears to change with the stage of pregnancy.

Penetration of Boundary may be suggestive of the emotional dis

equilibrium associated with the third trimester.

3. Comparison with norms indicated that the general level of anxiety

was greater for this sample of pregnant women than for the

normal population. Perhaps anxiety could be considered a

characteristic of most pregnancies. Positive attitudes toward

pregnancy were associated with a lower level of anxiety.

4. Some attitudes toward pregnancy were associated with a value

orientation for social acceptance and recognition. Social 120

interaction may be a significant factor during childbearing.

5. The strong intercorrelation among inferred values would seem

to indicate that the instrument may be measuring some larger

concept, such as the value one puts on clothing.

6. Primigravidae and multigravidae who attend prenatal clinics

appear to be similar in their level and type of adjustment,

and the values inferred through their clothing choices.

7. The adjust.ment process of pregnancy is a complex one. There

seems to be a danger of generalizing about characteristics

in general. It is highly possible that a combi~ation of vari-

ables, rather than a single variable, cont.ributes to the type

of adjustment during pregnancy.

Recommendations

On the basis of this study the following recommendations are made for further research.

1. The role of the prenatal class in ameliorating the

problems of adjustment for the pregnant woman through

education could be investigated by a comparison of

pregnant women who attend clinics with those who do not

attend. This comparison might yield the needed informa-

tion regarding motivation for attendance. This in turn

might suggest different modes of adjustment for the preg-

nant woman who does not attend prenatal classes.

il 2. The definition of the obstetric population who attend pre- !!

natal classes should be investigated so that the education-

al program will meet the needs of those attending. The 121

need to examine the socioeconomic and educational levels

of women attending prenatal clinics seems to be evident.

3. This study indicated significant differences in each tri-

mester on some variables. An in-depth longitudinal study

of the same women as they progress through each stage of

pregnancy to parturition could disclose further differences.

4. The adjustment of the unmarried pregnant woman needs to

be investigated with relationship to the variables examined

in this study. Social interaction appears to be important

to some pregnant women, and if illegitimate pregnancy

is censured by society, this social approval might be

denied the woman.

5. Much of the available data are based on studies with

groups of pregnant women exhibiting certain characteristics,

or behaviors. More research investigating the normal

emotional reactions during pregnancy and employing estab-

lished instruments to gain greater rigor in the design

and methodology of the study, appears necessary.

6. Further studies, on other populations, need to be under-

taken to establish greater reliability and validity in

the Inferred Values of Clothing Inventory. This study

suggested that self-expression should not be defined as

part of the aesthetic value, as all values could be rein-

forced through clothing choices which also maximize self-

expression.

7. Coherence between values held and behavioral manifestation

of these values could be confirmed by actual experimentation

i I 122

using various styles, fabrics, and types of maternity

clot,hing with individuals exhibiting particular person-

ality characteristics. This could suggest why there is

a particular rank order of values for pregnant women,

with regard to clothing,

80 The prevalence within this sample, of the social values

being ranked low, perhaps supports recent studies in con-

sumer behavior that indicate a change in why we consume

the way we doo The motivation for consumer choices could

be investigated to confirm or refute the notion that

with increased emphasis on the individual rather than on

others, motivation in buying is related to aesthetic, ec-

onomic! and comfort values rather than social valueso

90 If the person who values psychic comfort uses clothing for

the reinforcement of many values, an examination of indi-

I I viduals ranking psychic comfort as high, may contribute to

a knowledge and understanding of the part clothing plays

in the development and maintenance of the self,

100 If Barrier serves to maintain homeostasis during periods

of stress, one's true expression of values, and one's

level of adjustment as measured by other indices, may be

disguisedc Other measures of body-image, perhaps less

subconscious, might reveal more information about the way

in which the pregnant woman perceives her body. Measures

of body awareness or body cathexis might show more cor-

relation with clothing measures, particularly if pregnancy

is regarded as a temporary event. Concurrent studies 123

1nvestlgating body-image and clothing-related behavior

suggest that orientations to clothing other than values

might relate s~gnl,ficantly to measures of body-image

in pregnant WOIDen0

11 c Penetration appears t.c be an important personality

~","'a.riabl€ in pregnant women e Increased understanding of

Penetrati~n ~s necessary! particularly with respect to

i.ts role in personal:,ty projection and empathyo 124

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Ferreira, Ao J c 19680 The pregnant woman! s emotional att,.itude and its reflection cn the newborn, po259-265o In Ro Fc Winch and

LoW c Goodrnan (Eds e } 0 Selected studies in marriage and the family 0 Third editio~e Holt, Rinehart, and Winston, Inco, New Yorke

Ferreira, Ao Jo 1969, Prenatal environmente Charles Co Thomas, springfield, Illinois,

Fisher, So, and S. Eo Clevelandc 19680 Body image and personalityo

Second revised editiono Dover publications, Inc., New York 0

Fitzpatrick, M. A., N. J. Eastman" and S. R. Reeder. 1966c Maternity

nursingc Eleventh edition 0 J. Be Lippincott COo, Philadelphia c ,

Fleming, J. 19680 Body image boundaries and clothing fabric prefer ences of young women with physical disabilities~ MS thesis~ Utah State University, Logan, Utaho

Plugsl, Jo Co 1969~ The psychology of clothese First paperback edition. International Universities Press, Inco, New Yorko 127

Fromm-Reichman fI F c 19550 An, outline of psychoanalysis 0 Random House! Inca! New Yorke

Garma, Ac 19490 The origin of clotheso Psychoanalytical Quarterly 18~173-190,

Gergen, Ko Jo, and Do Marlowe (Edso)o 19700 Personality and social

behavior 0 Addison-Wesley Publishing Coo, Reading, Massachusetts~

Goffman, Eo 19590 The presentation of self in everyday lifeo Doubleday and Company, Inco, Garden City, New Yorko

Goshen-Gottstein, Eo Ro 19660 Marriage and first pregnancyo Tav

istock Publi;:;ations, 3c Bo Lippincott Coo, Philadelphia 0

Gould, Jo, and Wo Kolb (Eds,,}o 19640 A dictionary of the social

sciencesc The Free Press, New York 0

Grimm, Eo Ro 19610 Psychological tension in pregnancyo Psycho somatic Medicine 23~6) :520-5270

Grimm, Ec Ro 19620 Psychological investigation of habitual abortion 0

Psychosomatic; Medicine 24 (4 y : 369 0

Grimm, .Eo Ro 19670 Psychological and social factors in pregnancy,

del~very! a,,'1d o;Jlt;:;ome 8 pol-52o In So Ao Richardson! and Ao Fa Guttmacher tEdSa)0 Childbearlong - its social and psychological

aspects a Williams and Wilkins COO! Baltimore, Maryland 0

GriIDJr, Eo Ro 19680 NOb'ms and details regarding scoring of HoIoPo Pregna.,l"),cy Questionnairec Letter to write.r I September 22, 19710

Grimm, Eo R0 8 and Wo Ro Veneto 19660 The relationship of emotional adjustment and attitudes to the coyrse and outcome of pregnancyo Fsychosomati~ Medicine 28:34-490

Groseclose, Bo Co 19580 Clothing for pregnant women o Unpublished

MS thes1so Virginia Polytechnic Institute, Blacksburg, Virginia 0

Hall, Eo To 19590 The silent languageo Fawcett Publications, Inco, Greenwi~h, Connectic;Jlto

Hall! Go So 1897 0 Some aspects of the early sense of self' 0 &~erican Journal of Psychiatry 9:351-3690

Harms, Eo 19380 The psychology of clotheso American Journal of Sociology 44:239-250.

Hartmann, Go W~ 19490 Clothing: personal problems and social issueo Journal of Home Economics 41(6):295-2980

Hiller, Go, and Bo White 0 [1971]0 Unpublished research projecto

Utah State University, Loganu Utah 0 128

Hirst, J. C., and F. Strousse. 1938. The origin of emotional factors in normal pregnant women. American Journal of the Medical Sciences 196:95-99.

Holmes, T. H., and M. Masuda. 1970. Life change and mental illness susceptibility. A paper presented at the annual meeting of the American Association for the Advancement of Science, Chicago, Illinois. December 26-30, 1970.

Holtzman, W., J. Thorpe, H. Swartz, and E. Herron. 1961. Inkblot perception and personality. University of Texas Press, Austin, Texas.

Horn, M. J. 1968. The second skin. Houghton Mifflin Co., Boston, Massachusetts.

Humphrey, C., M. Klassen, and A. Creekmore. 19710 Clothing and self-concept of adolescentse Journal of Home Economics 63(4): 246-250.

Hurlock, E. 1929. Psychology of dress. The Ronald~Press Co., New York.

111s1ey, R. 19670 The sociological study of reproduction and its outcome, p.75-14l. In So A. Richardson, and A. F. Guttmacher (Edso). Childbearing - its social and psychological aspects. Williams and Wilkins Co., Baltimore, Maryland.

Ingalls, A. J. 1967. Maternal and child health nursing. c. V. Mosby Co., Saint Louis, Missouri.

Jacob, P. E., and J. J. Flink. 1962. Values and their function in decision-making. Supplement to: the American Behavioral Scientist V (Supplement #9)0

i I

Jersild, A. To 1952. In search of self. Teachers College, Columbia I University, New York.

John, M. E. 1966. Classification of values that serve as motiva tors to consumer purchases. Journal of Farm Economics 38:956-963.

Kernaleguen, Ao P. 1968. Creativity level, perceptual style and peer perception of attitudes toward clothing. Unpublished PhD dissertation. Utah State University, Logan, Utah.

Kernaleguen, A. Po 1970. Selected perceptual and personality var iables related to orientation in dress and adornment. Utah State Research Grant, U-500. Unpublished research.

Kernaleguen, Ao P. 1971. Inferred values of clothing inventory. Unpublished instrument and manual. Edmonton, Alberta. 129

Klassen, M. G. 1967. Self esteem and its relationship to clothing. Unpublished MA thesis. Michigan State University, East Lansing, Michigan.

Kleh, Le 19540 A study of the buying practices concerning the mater~ity wardrobes of a selected group of womeno Unpublished MS thesis. University of Maryland, College Park, Maryland.

Klein, He Ro, H. W. Potter, and Re B. Dyke 1950. Anxiety in preg nancy and childbirth. Paul B. Hoeber, Inc., New York.

Kroger, W. So, and S. Co Freed. 19620 Psychosomatic gynecology. Wilshire Book COe, Hollywood, Ca11fornia.

Labenne, W. D., and B. I. Greenec 1969. Educational implications of self-concept theory. Goodyear Publishing Co. Inc., California.

Lapitsky, M. 19610 Clothing values and their relation to general values and t,o social security and insecurity. Unpublished PhD dissertati~n. Pennsylvania State University, University Park,

Pennsylvania 0

Lazarus, R. S. 1963. Personallty and adjustment. Prentice-Hall Inc., Englewcod Cliffs, New Jersey.

Lazarus, Ro So 1967. Cogn~tive and personality factors underlying threat and coping. In M. H. Appley and Ro Trumbull (Eds.). Psychological stress-c- Appleton-Century-Crofts, New York.

Lazarus, Rc So, J. Deese, and S. F, Osler. 1952. The effect of psy,::hological stress upon performance. Psychological Bulletin 49(4): Part I, 293-3170

Lazarus, R. S., and C. W. Eriksenc 1952. Psychological stress and its personality correlates: Part I. The effects of failure stress upon skilled performanceo Journal of Experimental Psychology 43:100-105.

Lovejoy, A. O. 1950. Terminal and adjectival values. Journal of Philosophy 46:593-608.

Lubic, R. W. 1969. Sociocultural aspects of maternity caree Maternity Briefs 33~9) :131-134.

Machover, K. 19490 Personality projection in the drawing of the human figure. Charles Thomas, Springfield, Illinois.

McConnell, O. L., and P. G. Daston. 1961. Body image changes in pregnancy_ Journal of Projective Techniques 25:451-455.

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Mega~gee8 Ee 1965, Rela:'-l:;r: bet;ween barrier scores and agressive behavlcrc J:;.l.,,1;:ca: cf Abnormal Psychcl:)gy 1: 307-3110

l Meiklejchno He 1938c Dresses F pc304c:;:n Wo Hamilton '''Eda c Price and pr:ce poli=~es McGraw-Hill Boeke:;,,! New Yerk.

Meyer::;witz" H 1970c Satl,sfactio:r: durlng pregnancyo Journal af Ma!:'lC1.,age a:,.;d t:he Faml-.ly 32: 38-42,

Moomaw, Ee 194 0 A s4~vey of sources of infcrmation and compila

~io.n :tf sugges,,:~,cr:s f'·~r a rna t,er:1i ty ward:r'\::be 0 Unpublished MS

thesis 0 Oh==:;Sta~e Uc.;" ?ersl.ty if CcltLwus" Ohio 0

Morris ,_ CoW c (Ed c 19620 M:,nd I self, and sO:::lety 0 From the

s tandpc;tr;,t. :::.f :a~ s::: ::~al behavicrist George H 0 Mead 0 Uni versi ty of ChL~agc Press" :h~cagco

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and stJC1::;~ur8 J Basic Books lI Inco! Publishers" New Yorke

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F:;rurn: 3 J

Stat~st==cs in rsseaxcho Iowa state University

Ottinger, D Rc! and 30 EcSirnmo!lso 19640 Beha"l1or of human ne::mates

and prsr::.atal maternal anxiety 0 Psychological Reports 14:341-3940

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Washington state Un~versitYI Pullman, Washington 0 134

APPENDICES 135

Appendix A

General Information Questionnaire

Name Telephone Number

Present Address Place of Residence farm ---town ---city Please circle the number which indicates the highest educational level you have completed: Grade 8 9 10 11 12 College or technical training 1 2 3 4 5

Husband's occupation

Your occupation

If working now, till what month will you continue to work? Check the appropriate category: ---under 20 ---20-24 years ---25-29 years ---30-34 years ---35 or older Will this be your first pregnancy? __~yes ---no Have you ever lost a child before? __~yes ---no Did you plan to have the baby at this particular time? yes ---no In what month do you expect to have your baby?

__Nov .. , Dec 0' __Jan ~, __Feb 0 , __Mar 0 , __Apr. ,

__May , __J~e , __July I __Aug 0 I __Sept 0 , Octo

During what month did you or will you begin to wear maternity clothes? __May, __June! __July, __Aug e, __Septa, __OctQ,

__NOVe I __Deco! __Jan", __Febe, __Marc, __Apr 0 136

Appendix B

Instructions to Members of Sample

We are studying the experiences of women during pregnancy, what they think, how they feel, and what their problems may be.

By learning more about these feelings and concerns we hope that maternity care can be improved. We are therefore asking you and other expectant mothers to take about 30 minutes of your time to answer some questions. What you tell us is importqnt and we hope you will be as honest and as accurate as you can. Your papers will be identified only by number - absolutely no one you know, not even the doctors and nurses, will have any idea of how you answer. The only page with your name on it is the last one, and the purpose of this page is to contact you if necessary to complete the testing.

Part of the questions will be completed here in this group.

Most of the statements require only a checkmark. Please answer every question or statement. There are no right or wrong answers, and none that are better than others. If you are not sure, or if no answer seems to fit exactly what you want to say, check the one

that comes closest to what you have in mind. As you finish and hand

in these questions, we can arrange a convenient time for you to meet with me for an additional 20 minutes, for the individual test-

ing. After the testing has been completed, I'll be happy to talk with

any of you about the research. If you do not wish to participate, you may simply leave. I would like to emphasize that we are only interested

in group scores. Thank you for your help and cooperation. 137

Appendix C

Location of SaIllple :------r PROVINCE OF SASKATCHEWAN

f f «• f ....J,J-f « :

I I ...... ,,------.L r --- -,, N.DAK. ~--...... -...

Eatonia

, \ .Cabri , ,\ ... '. Moose Jaw. Swi f t Current .. Gull lake.

f N

e3:=ea::=:::100m. 138

VITA

Violet Elizabeth Dowdeswell

Candidate for the Degree of

Master of Science

Thesis: Inferred Values of Clothing Related to Adjustment Among Pregnant Women

Major Field: Home Economics and Consumer Education (Clothing and Textiles)

Biographical Information:

Personal Data: Born at Belfast, Northern Ireland, November 9, 1944, daughter of J. Annette and Desmond G. Patton; married Donald D. Dowdeswell December 23, 1966.

Education: Graduated from Briercrest High School in 1962; received Bachelor of Science degree in Home Economics from the University of Saskatchewan specializing in Clothing and Textiles in 1966; completed requirements for the Master of Science degree in Home Economics and Consumer Education at Utah State University in 1972.

Professional Experience: 1966-69, teacher of Home Economics at O.M.Irwin Collegiate, Swift Current, Saskatchewan; 1969-72, teacher of Home Economics at Swift Current Comprehensive High School, Swift Current, Saskatchewan.